Clinical performance and biocompatibility of hyaluronan-based heparin-bonded extracorporeal circuits in different risk cohorts.
This prospective randomized study compares novel hyaluronan-based heparin-bonded circuits vs. uncoated controls across EuroSCORE patient risk strata including biomaterial evaluation. Over a two-year period, 90 patients undergoing coronary artery bypass grafting were prospectively randomized to one of the two perfusion protocols: Group 1 was treated with hyaluronan-based heparin-bonded preconnected circuits (Vision HFO-GBS, Gish, CA, USA) and Group 2 with identical uncoated controls. Each group was composed of three subgroups (n=15) with respect to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high (6+) risk patients. Blood samples were collected after induction (T1) and heparinization (T2), 15 min after cardiopulmonary bypass start (T3), before cessation of CPB (T4), 15 min after reversal (T5), and the first postoperative day (T6). In high-risk patients, platelet counts demonstrated significant preservation at T4, T5 and leukocyte counts were lower at T5 in hyaluronan group (P<or=0.05 vs. control). C3a (ng x ml(-1)) levels were significantly lower at T3 (0.2+/-0.04 vs. 0.31+/-0.05), T4 (0.25+/-0.04 vs. 0.51+/-0.05), T5 (0.38+/-0.04 vs. 0.56+/-0.05) and interleukin-6 (pg x ml(-1)) at T4 (91+/-18 vs. 124+/-20), T5 (110+/-20 vs. 220+/-25) in coated group vs. control (P<or=0.05). Protein desorption (microalbumin) on fibers (mg x mm(-3)) was less in hyaluronan vs. control groups (P<or=0.05). Hyaluronan coating reduced platelet adhesion and cell adsorption, and modulated inflammatory response in high-risk patients.
Gunaydin
Serdar
S
University of Kirikkale, Angora Evleri G-8 Bl. No: 1, Ankara, Turkey. sgunaydin@isnet.net.tr
McCusker
Kevin
K
Sari
Tamer
T
Onur
Mehmet Ali
MA
Zorlutuna
Yaman
Y
D000925:Anticoagulants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D039481:CD11b Antigen / Q000097:blood; D018821:CD18 Antigens / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003176:Complement C3 / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D006820:Hyaluronic Acid; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010973:Platelet Adhesiveness / Q000187:drug effects; D010976:Platelet Count; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D015415:Biomarkers; C038245:C3 protein, human; D039481:CD11b Antigen; D018821:CD18 Antigens; D020099:Coated Materials, Biocompatible; D003176:Complement C3; C508600:IL6 protein, human; C509295:ITGAM protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D006820:Hyaluronic Acid; D006493:Heparin