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A closed perfusion system with heparin coating and centrifugal pump improves cardiopulmonary bypass biocompatibility in elderly patients.

Författare och institution:
Lena Lindholm (Hjärt-kärlinstitutionen); Martin Westerberg (Hjärt-kärlinstitutionen); Anders Bengtsson (Institutionen för de kirurgiska disciplinerna); Rolf Ekroth (Hjärt-kärlinstitutionen); Eva Jensen (Institutionen för de kirurgiska disciplinerna); Anders Jeppsson (Hjärt-kärlinstitutionen)
Publicerad i:
The Annals of thoracic surgery, 78 ( 6 ) s. 2131-8; discussion 2138
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
BACKGROUND: Cardiopulmonary bypass induces a systemic inflammatory and hemostatic activation, which may contribute to postoperative complications. Our aim was to compare the inflammatory response, coagulation, and fibrinolytic activation between two different perfusion systems: one theoretically more biocompatible with a closed-circuit, complete heparin coating, and a centrifugal pump, and one conventional system with uncoated circuit, roller pump, and a hard-shell venous reservoir. METHODS: Forty-one elderly patients (mean age, 73 +/- 1 years, 66% men) undergoing coronary artery bypass grafting or aortic valve replacement were included in a prospective, randomized study. Plasma concentrations of complement factors (C3a, C4d, Bb, and sC5b-9), proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-8), granulocyte degradation products (polymorphonuclear elastase), and markers of coagulation (thrombin-antithrombin) and fibrinolysis (D-dimer, tissue plasminogen activator antigen and tissue plasminogen activator-plasminogen activator inhibitor-1 complex) were measured preoperatively, at bypass during rewarming (35 degrees C), 60 minutes after bypass, and on day 1 after surgery. RESULTS: The mean concentrations of C3a (-39%; p = 0.008), Bb (-38%; p < 0.001), sC5b-9 (-70%; p < 0.001), interleukin-8 (-60%; p = 0.009), polymorphonuclear-elastase (-55%; p < 0.003), and tissue plasminogen activator antigen (-51%; p = 0.012) were all significantly lower in the biocompatible group during rewarming. Sixty minutes after bypass, the mean concentrations of sC5b-9 (-39%; p = 0.006) and polymorphonuclear-elastase (-55%; p < 0.001) were lower in the biocompatible group. CONCLUSIONS: The results suggest that a closed perfusion system with a heparin-coated circuit and a centrifugal pump may improve cardiopulmonary bypass biocompatibility in elderly cardiac surgery patients in comparison with a conventional system.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin ->
Aged, Anticoagulants, pharmacology, Blood Coagulation, drug effects, Cardiac Surgical Procedures, Cardiopulmonary Bypass, instrumentation, Coated Materials, Biocompatible, Complement Activation, drug effects, Coronary Artery Bypass, Cytokines, drug effects, Female, Fibrinolysis, drug effects, Heart Valve Prosthesis Implantation, Heparin, pharmacology, Humans, Inflammation, prevention & control, Male, Perfusion, instrumentation, Postoperative Complications, prevention & control, Prospective Studies
Postens nummer:
Posten skapad:
2007-10-18 19:45
Posten ändrad:
2011-01-20 09:59

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