Differences in blood activation related to roller/centrifugal pumps and heparin coated/uncoated surfaces in a cardiopulmonary bypass model circuit

Abstract

An in vitro model cardiopulmonary bypass (CPB) circuit consisting ot tubing, oxygenator and venous reservoirs with either a roller or a centrifugal pump, and with either heparin-coated (Carmeda Bioactive Surface, CBAS) or uncoated surfaces, was studied with respect to 'blood activation', using small- scale-based blood volume (450 + 500 ml). Sixteen circuits were tested in each pump group, eight with and eight without heparin-coated surfaces, by circulating heparinized fresh human blood for 72 hours at 30°C. Blood plasma, sampled at defined intervals, was analysed for haemolysis (lactate dehydrogenase and potassium), complement activation (C3bc and C5b-9 (TCC)), complement lytic inhibitors (vitronectin and clusterin), coagulation activation (fibrinopeptide A), granulocyte (lactoferrin and myeloperoxidase) and platelet (β-thromboglobulin) activation and contaminating endotoxin. The heparin coating significantly reduced the concentrations of C3bc, TCC, fibrinopeptide A, lactoferrin, myeloperoxidase and β-thromboglobulin. The two pump types did not differ with respect to these parameters, but the roller pump caused significantly higher increases in plasma LDH and potassium and significantly greater reductions in clusterin and vitronectin than the centrifugal pump. Endotoxin concentration was low at the start and after 24 hours in all groups. These results confirm that heparin-coated CPB surfaces reduce blood activation, and suggest that centrifugal pumps cause less haemolysis and less reduction in lytic complement inhibitors than roller pumps.

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References

Hoerr HR , Kraemer MF , Williams JL et al. In vitro comparison of the blood handling by the constrained vortex and twin roller blood pumps. J Extra-Corpor Technol 1987; 19(3): 316-21.

Horton AM , Butt W. Pump-induced haemolysis: is the constrained vortex pump better or worse than the roller pump? Perfusion 1992; 7: 103-108.

Mollnes TE , Videm V. , Riesenfeld J. et al. Complement activation and bioincompatibility. Clin Exp Immunol 1991; 86 (suppl 1): 21-26.

van Oeveren W. , Wildevuur Crh , Kazatchkine MD Biocompatibility of extracorporeal circuits in heart surgery. Transfus Sci 1990; 11: 5-33.

Kirklin JK , Westaby S. , Blackstone EH et al. Complement and the damaging effects of cardiopulmonary bypass . J Thorac Cardiovasc Surg 1983; 86: 845-57.

Davies GC , Sobel M. , Salzman EW Elevated plasma fibrinopeptide A and thromboxane B2 levels during cardiopulmonary bypass. Circulation 1980; 61: 808-14.

Colman RW Platelet and neutrophil activation in cardiopulmonary bypass. Ann Thorac Surg 1990; 49: 32-34.

Kirklin JK , Chenoweth DE , Naftel DC et al. Effects of protamine administration after cardiopulmonary bypass on complement, blood elements, and the hemodynamic state. Ann Thorac Surg 1986; 41: 193-99.

Pekna M. , Nilsson L. , Nilsson-Ekdahl K. et al. Evidence of iC3 generation during cardiopulmonary bypass as the result of blood-gas interaction. Clin Exp Immunol 1993; 91: 404-9.

10.

van Oeveren W. , Kazatchkine MD , Descamps-Latscha B. et al. Deleterious effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1985; 89: 888-99.

11.

Mammen EF , Koets MH , Washington BC et al. Hemostasis changes during cardiopulmonary bypass surgery. Semin Thromb Hemost 1985; 11(3): 281-92.

12.

Podack ER , Kolb WP , Muller-Eberhard HJ SC5b-7 complex: Formation, isolation, properties, and subunit composition . J Immunol 1977; 119: 2024-29.

13.

Dahlback B. , Podack ER Characterisation of human S-protein, an inhibitor of the membrane attack complex of complement demonstration of a free reactive thiol group. Biochemistry 1985; 24: 2368-79.

14.

Murphy BF , Saunders JR , O'Bryan MK et al. SP-40 is an inhibitor of C5b-6 initiated haemolysis. Int Immunol 1989; 1: 551-54.

15.

Morgan P. Complement membrane attack on nucleated cells: resistance, recovery and non-lethal effects. Biochem J 1989; 264: 1-14.

16.

Fenton JW Thrombin functions and antithrombotic intervention. Thromb Haemost 1995; 74(1): 493-98.

17.

Videm V. , Mollnes TE , Garred P. et al. Biocompatibility of extracorporeal circulation. In vitro comparison of heparin-coated and uncoated oxygenator circuits. J Thorac Cardiovasc Surg 1991; 101: 654-60.

18.

Fosse E. , Moen O. , Johnson E. et al. Reduced complement and granulocyte activation with heparin-coated cardiopulmonary bypass. Ann Thorac Surg 1994 ; 58: 472-77.

19.

Jakob HG , Hafner G. , Theleman C. et al. Routine extracorporeal circulation with a centrifugal or roller pump. ASAIO Trans 1991; 37(3): M487-89.

20.

Moen O. , Fosse E. , Bråten J. et al. Roller and centrifugal pumps compared in vitro with regard to haemolysis, granulocyte and complement activation. Perfusion 1994; 9: 109-17.

21.

Jakob HG , Kutschera Y. , Palzer B. et al. In-vitro assessment of centrifugal pumps for ventricular assist . Artif Organs 1990; 14(4): 278-83.

22.

Nordisk enzymkomite: Recommended method for the determination of four enzymes in blood. Scand J Clin Lab Invest 1974; 33: 291-302.

23.

Garred P. , Mollnes TE , Lea T. Quantification in enzyme-linked immunosorbent assay of a C3neoepitope expressed on activated human complement factor C3. Scand J Immunol 1988; 121: 329-35.

24.

Mollnes TE , Lea T. , Frøland SS et al. Quantification of the terminal complement complex in human plasma by an enzyme-linked immunosorbent assay based on monoclonal antibodies against a neoantigen of the complex. Scand J Immunol 1985; 22: 197-202.

25.

Høgåsen K. , Mollnes TE , Tshopp J. et al. Quantification of vitronectin and clusterin. Pitfalls and solutions in enzyme immunoassays for adhesive proteins. J Immunol Methods 1993; 160: 107-15.

26.

Høgåsen K. , Mollnes TE , Harboe M. Heparin-binding properties of vitronectin are linked to complex formation as illustrated by in vitro polymerisation and binding to the terminal complement complex. J Biol Chem 1992; 267(32): 23076-82.

27.

Skjønsberg OH , Kierulf P. , Fagerhol MK et al. Thrombin generation during collection and storage of blood. Vox Sang 1986; 50: 33-37.

28.

Olofsson T. , Olsson I. , Venge P. et al. Serum myeloperoxidase and lactoferrin in neutropenia. Scand J Haematol 1977; 18: 73-80.

29.

Brandtzaeg P. , Kierulf P. , Gaustad P. et al. Plasma endotoxin as a predictor of multiple organ failure-and death in systemic meningococcal disease. J Infect Dis 1989; 159: 195-204.

30.

Altman DG Practical statistics for medical research. London: Chapman and Hall, 1991: 213-15.

31.

Salama A. , Hugo F. , Heinrich D. et al. Deposition of terminal C5b-9 complement complexes on erythrocytes and leukocytes during cardiopulmonary bypass. N Engl J Med 1988; 318: 408-14.

32.

Ferbers EW , Kirklin JW Studies of hemolysis with a plastic-sheet bubble oxygenator. J Thorac Surg 1958; 36: 23-32.

33.

Vasilakis A. , Rozar GE Jr , Hill RC et al. Left atrial to femoral arterial bypass using the Biomedicus pump for operation of the thoracic aorta. Am Surg 1990; 56(12): 802-5.

34.

Pedersen TH , Karlsen H. , Wolden R. et al. Does negative pressure on the inlet side cause hemolysis during extracorporeal circulation with a centrifugal pump? Abstract presented at the 13th Annual San Diego Cardiothoracic Surgery Symposium, Pathophysiology and Techniques of Cardiopulmonary Bypass, San Diego, CA, 1993; p 200.

35.

Kletschka HD , Rafferty EH , Olsen DA et al. Artificial heart: III. Development of efficient atraumatic blood pump. A review of the literature concerning in vitro testing of blood pumps for hemolysis. Minn Med 1975; 58: 756-81.