Clinical evaluation of new generation oxygenators with integrated arterial line filters for cardiopulmonary bypass.
New generation oxygenators with integrated arterial line filters have been marketed to improve the efficacy of cardiopulmonary bypass (CPB). Differences in designs, materials, coating surfaces, pore size of arterial filter, and static prime exist between the oxygenators. Despite abundant preclinical data, literature lacks clinical studies. From September 2010 to March 2011, 80 consecutive patients were randomized to CPB using Terumo Capiox FX25 (40 patients, Group-T) or Sorin Synthesis (40 patients, Group-S) oxygenators. Pressure drop and gas exchange efficacy were registered during CPB. High-sensitivity C-reactive protein (hs-CRP), white blood cells (WBCs), fluid balance, activated clotting time, international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, platelets (PLTs), serum albumin, and total proteins were measured perioperatively at different timepoints. Clinical outcome was recorded. Repeated measure analysis of variance and nonparametric statistics assessed between-groups and during time differences. The two groups showed similar baseline and intraoperative variables. No differences were recorded in pressure drop and gas exchange (group-P and group*time-P = N.S. for all) during CPB. Despite similar fluid balance (P = N.S. for static/dynamic priming and ΔVolume administered intraoperatively), Group-T showed higher hs-CRP (group-P = 0.034), aPTT (group-P = 0.0001), and INR (group-P= 0.05), with lower serum albumin (group-P = 0.014), total proteins (group-P = 0.0001), fibrinogen (group-P = 0.041), and PLTs (group-P = 0.021). Group-T also showed higher postoperative bleeding (group-P = 0.009) and need for transfusions (P = 0.008 for packed red cells and P = 0.0001 for fresh frozen plasma and total transfused volumes). However, clinical outcome was comparable (P = N.S. for all clinical endpoints). Both oxygenators proved effective and resulted in comparable clinical outcomes. However, Sorin Synthesis seems to reduce inflammation and better preserve the coagulative cascade and serum proteins, resulting in lower transfusions and post-CPB inflammatory response.
Division of Cardiac Surgery Laboratorio Analisi Chimico-Cliniche ed Ematologiche, University of Verona Medical School, Verona, Italy. frankono@libero.it
Francesco
F
Onorati
Francesco
F
Santini
Federica
F
Raffin
Tiziano
T
Menon
Maria S
MS
Graziani
Bartolomeo
B
Chiominto
Aldo
A
Milano
Giuseppe
G
Faggian
Alessandro
A
Mazzucco
D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D002097:C-Reactive Protein / Q000276:immunology; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D005260:Female; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D010106:Oxygenators / Q000009:adverse effects; D010976:Platelet Count; D011659:Pulmonary Gas Exchange; D062666:Vascular Access Devices
D002097:C-Reactive Protein