title: Hyaluronan based heparin free coated open and closed extracorporeal circuits for high risk coronary revascularization.
abstract: This prospective randomized study compares the inflammatory response and fibrinolytic activation of fully coated/uncoated and open/closed extracorporeal circuits (ECC) in high risk patients. Over a 2-month period, 48 patients with EuroSCOREs 6 or greater undergoing coronary revascularization were prospectively randomized to one of the four perfusion protocols: Group 1: Closed and totally hyaluronan based heparin free coated (Vision HFO-GBS-HF, Gish Biomedical, Rancho Santa Margarita, CA) ECC with a soft-shell coated venous reservoir (SVR11S2-HFC, Gish Biomedical) and a hard-shell cardiotomy (CAPVRF44, Gish Biomedical) (n = 12); Group 2: Closed and totally uncoated identical ECC with soft-shell uncoated venous reservoir and a hard-shell cardiotomy (n = 12); Group 3: Open, totally hyaluronan based heparin free coated ECC (n = 12); and Group 4: Control-open, uncoated ECC (n = 12). Blood samples were collected at T1: Baseline; T2: 15 minutes after cardiopulmonary bypass (CPB) initiation; T3: before cessation of CPB; T4: 15 minutes after protamine reversal, and T5: in the intensive care unit. Serum IL-6 levels were significantly lower at T2 in all study groups, at T3 for coated groups, and T4 for closed+coated group (p < .05 versus control). Creatine kinase M-band (MB) levels in coronary sinus blood demonstrated well preserved myocardium after CPB in both coated groups versus Control (p < .05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups versus control at T2, for both coated groups at T3 and only for closed + coated group at T4 (p < .05). Postoperative hemorrhage (mL) was 510 +/- 40 in closed + coated and 536 +/- 40 in open + coated groups (control: 784 +/- 48, p < .05). No significant differences in thrombin-antithrombin complex and free plasma hemoglobin were observed. Desorbed protein amount on ECC (mg/dL) was 1.7 +/- .01 in closed+coated, 2.01 +/- .01 in open+coated, and 3.3 +/- .015 in control groups (p < or = .05). Use of a closed and completely heparin free coated ECC may reduce neutrophil degradation, cytokine release characterized by improved clinical outcomes including reduced blood loss, reduced requirement for inotropes, and reduced atrial fibrillation.
authors.affiliation: University of Kirikkale-Turkey, Ankara, Turkey. sgunaydin@isnet.net.tr
authors.forename: Serdar
authors.initials: S
authors.lastname: Gunaydin
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Ucar
authors.forename: Tanzer
authors.initials: T
authors.lastname: Serter
authors.forename: Kevin
authors.initials: K
authors.lastname: McCusker
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozcelik
authors.forename: Nevriye
authors.initials: N
authors.lastname: Salman
authors.forename: Ali Cem
authors.initials: AC
authors.lastname: Yorgancioglu
mesh_terms: D020099:Coated Materials, Biocompatible / Q000737:chemistry*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005260:Female; D006493:Heparin / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry*; D007249:Inflammation / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D006820:Hyaluronic Acid; D006493:Heparin