Restricted accessResearch articleFirst published online 2016-4
A prospective randomized trial comparing the clinical effectiveness and biocompatibility of heparin-coated circuits and PMEA-coated circuits in pediatric cardiopulmonary bypass
We compared the clinical effectiveness and biocompatibility of poly-2-methoxyethyl acrylate (PMEA)-coated and heparin-coated cardiopulmonary bypass (CPB) circuits in a prospective pediatric trial.
Methods:
Infants randomly received heparin-coated (n=7) or PMEA-coated (n=7) circuits in elective pediatric cardiac surgery with CPB for ventricular septum defects. Clinical and hematologic variables, respiratory indices and hemodynamic changes were analyzed perioperatively.
Results:
Demographic and clinical variables were similar in both groups. Leukocyte counts were significantly lower 5 minutes after CPB in the PMEA group than the heparin group. Hemodynamic data showed that PMEA caused hypotension within 5 minutes of CPB. The respiratory index was significantly higher immediately after CPB and 1 hour after transfer to the intensive care unit (ICU) in the PMEA group, as were levels of C-reactive protein 24 hours after transfer to the ICU.
Conclusion:
Our study shows that PMEA-coated circuits, unlike heparin-coated circuits, cause transient leukopenia during pediatric CPB and, perhaps, systemic inflammatory respiratory syndrome after pediatric CPB.
DayJRSTaylorKM.The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg2005; 3: 129–140.
2.
RanucciMMazzuccoAPessottoR. Heparin-coated circuits for high-risk patients: a multicenter prospective, randomized trial. Ann Thorac Surg1999;67: 994–1000.
3.
ShiSSChenCShuQ. The role of plasma gelsolin in cardiopulmonary bypass induced acute lung injury in infants and young children: a pilot study. BMC Anesthesiol2014; 14: 67.
4.
TarnokABocsiJHambschJ. Preoperative prediction of postoperative edema and effusion in pediatric cardiac surgery by altered antigen expression patterns on granulocytes and monocytes. Cytometry2001; 46: 247–253.
5.
UeyamaKNishimuraKNishinaTNakamuraTIkedaTKomedaM.PMEA coating of pump circuit and oxygenator may attenuate the early systemic inflammatory response in cardiopulmonary bypass surgery. ASIAO J2004; 50: 369–372.
6.
MangoushOPurkayasthaSHaj-YahiaS. Heparin-bonded circuits versus nonheparin-bonded circuits: an evaluation of their effect on clinical outcomes. Eur J Cardiothorac Surg2007; 31: 1058–1069.
7.
KutayVNoyanTOzcanSMelekYEkimHYakutC.Biocompatibility of heparin-coated cardiopulmonary bypass circuits in coronary patients with left ventricular dysfunction is superior to PMEA-coated circuits. J Card Surg2006; 21: 572–577.
8.
SaitoNMotoyamaSSawamotoJ.Effects of new polymer-coated extracorporeal circuits on biocompatibility during cardiopulmonary bypass. Artif Organs2000; 24: 547–554.
9.
ErethMHNuttallGAOliver JrWC. Biocompatibility of Trillium biopassive surface-coated oxygenator versus uncoated oxygenator during cardiopulmonary bypass. J Cardiothorac Vasc Anesth2001; 15: 545–550.
10.
GrossiEAKallenbachKColvinSB. Impact of heparin bonding on pediatric cardiopulmonary bypass: a prospective randomized study. Ann Thorac Surg2000; 70: 191–196.
11.
GottVLWhiffenJDDuttonRC.Heparin bonding on colloidal graphite surfaces. Science1963; 142: 1297–1298.
12.
ZimmermannAKAebertHReizA. Homocompatibility of PMEA coated oxygenators used for extracorporeal circulation procedure. ASAIO J2004; 50: 193–199.
13.
ThiaraASMollnesTEVidemV. Biocompatibility and pathways of initial complement pathway activation with Phisio- and PMEA-coated cardiopulmonary bypass circuits during open-heart surgery. Perfusion2010; 26: 107–114.
14.
HayashiTTanakaMYamamotoSShimomuraMHaraM.Direct observation of interaction between proteins and blood-compatible polymer surfaces. Biointerphases2007; 2: 119–125.
15.
KirshbomPMMillerBESpitzerK. Failure of surface-modified bypass circuits to improve platelet function during pediatric cardiac surgery. J Thorac Cardiovasc Surg2006; 132: 675–680.
16.
SuzukiYDitokuKMinakawaMFukuiKFukudaI.Poly-2-methoxyethylacrylate-coated bypass circuits reduce activation of coagulation system and inflammatory response in congenital cardiac surgery. J Artif Organs2008; 11: 111–116.
17.
EissesMJGeiduschekJMJonmarkerCCohenGAChandlerWL.Effect of polymer coating (poly-2-methoxyethylacrylate) of the oxygenator on hemostatic markers during cardiopulmonary bypass in children. J Cardiothorac Vasc Anesth2007; 21: 28–34.
18.
D’AmicoEJNeilandsTBZambaranoR.Power analysis for multivariate and repeated measures designs: a flexible approach using the SPSS MANOVA procedure. Behav Res Methods Instrum Comput2001; 33: 479–484.
19.
TaylorA. JMASM31: MANOVA procedure for power calculations (SPSS). J Modern Applied Statistical Methods2011; 10: 741–750.
20.
GunaydinSFarsakBKocakulakM. Clinical performance and biocompatibility of poly (2-methoxyethylacrylate)-coated extracorporeal circuits. Ann Thorac Surg2002; 74: 819–824.
21.
IkutaTFujiiHShibataT. A new poly-2-methoxyethylacrylate-coated cardiopulmonary bypass circuit possesses superior platelet preservation and inflammatory suppression efficacy. Ann Thorac Surg2004; 77: 1678–1683.
22.
HazamaSEishiKYamachikaS. Inflammatory response after coronary revascularization: off-pump versus on-pump (heparin-coated circuits and poly2methoxyethylacrylate-coated circuits). Ann Thorac Cardiovasc Surg2004; 10: 90–96.
23.
YonemuraKOhashiNKajimuraMHishidaA.Transient leukopenia and anaphylatoxin production during granulocyte apheresis as treatment for ulcerative colitis. J Clin Apheresis2002; 17: 107–110.
24.
TreacherDFSabbatoMBrownKAGantV.The effect of leucodepletion in patients who develop the systemic inflammatory response syndrome following cardiopulmonary bypass. Perfusion2001; 16: 67–73.
25.
DurandyY.Minimizing systemic inflammation during cardiopulmonary bypass in the pediatric population. Artif Organs2014; 38: 11–18.
26.
KochCLiLBlackstoneEH. Transfusion and pulmonary morbidity after cardiac surgery. Ann Thorac Surg2009; 88: 1410–1418.
27.
PatelNNLinHMurphyGJ. Interactions of cardiopulmonary bypass and erythrocyte transfusion in the pathogenesis of pulmonary dysfunction in swine. Anesthesiol2013; 119: 365–378.
