Complement consumption during cardiopulmonary bypass: comparison of Duraflo II heparin-coated and uncoated circuits in fully heparinized patients

Abstract

Heparin attachment to synthetic surfaces is one means of improving the biocompatibility of clinically used cardiopulmonary bypass (CPB) circuits. To assess the effect of heparin-coated circuits on complement consumption during CPB, 40 patients undergoing elective myocardial revascularization were prospectively randomized either to a group in which a completely Duraflo II heparin-coated circuit was used for perfusion (heparin-coated Group, n = 20 patients) or to a control group (n = 20 patients) in which an uncoated, but otherwise standard circuit was used. Full systemic heparinization was induced (activated clotting time, 480 seconds) in all the patients included in the study, regardless of which perfusion circuit was used. The two groups did not differ significantly in terms of bodyweight, aortic crossclamp and extracorporeal circulation times. No patient had difficulty in weaning from bypass and the postoperative period was uneventful in all patients. Concentrations of C3 and C4 were found to be within the 'normal' range in the prebypass period in both groups. There were no significant intergroup differences with regard to C3 and C4 consumption during CPB. We conclude that Duraflo II heparin- coated circuits have no effect in reducing complement consumption during CPB in fully heparinized patients.

Get full access to this article

View all access options for this article.

References

Sladen RN , Berkowitz DE Cardiopulmonary bypass and the lung. In: Gravlee GP , Davis RE , Utley JR eds. Cardiopulmonary bypass: principles and practice. Baltimore, MD: Williams & Wilkins, 1993; 468-87.

Chiu Rcj , Samson R. Complement (C3, C4) consumption in cardiopulmonary bypass, cardioplegia, and protamine administration. Ann Thorac Surg 1984; 37: 229-32.

Cavarocchi NC , Pluth JR , Schaff HV et al. Complement activation during cardiopulmonary bypass. Comparison of bubble and membrane oxygenators . J Thorac Cardiovasc Surg 1986; 91: 252-58.

Chenoweth DE , Cooper SW , Hugli TE , Stewart RW , Blackstone EH , Kirklin JW Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylotoxins . N Engl J Med 1981; 304: 497-503.

Videm V. , Svennevig JL , Fosse E. , Semb G. , Osterud A. , Mollness TE Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. J Thorac Cardiovasc Surg 1992; 103: 806-13.

Hsu LC Duraflo II heparin-immobilized cardiopulmonary bypass circuits. In: Ott RA , Gutfinger DE , Gazzaniga AB eds. Cardiac surgery: state of art reviews, Volume 7. Philadelphia, PA: Hanley & Belfus, Inc., 1993: 265-76.

Kirklin JK , George JF , Holman W. The inflammatory response to cardiopulmonary bypass. In: Gravlee GP , Davis RE , Utley JR eds. Cardiopulmonary bypass: principles and practice. Baltimore, MD: Williams & Wilkins, 1993: 235.

Hsu LC Heparin-coating of bypass circuits. Principles of heparin-coating techniques . Perfusion 1991; 6: 209-19.

Parker DJ , Cantrelli JW , Karp RB , Stroud RM , Digernes SB Changes in serum complement and immunoglobulins following cardiopulmonary bypass. Surgery 1972; 6: 824-27.

10.

Pekna M. , Borowiec J. , Fagerhol MK , Venge P. , Thellin S. Biocompatibility of heparin-coated circuits used in cardiopulmonary bypass . Scand J Thorac Cardiovasc Surg 1994 ; 28: 5-11.

11.

Svennevig JL , Geiran OR , Karlsen H. et al. Complement activation during extracorporeal circulation. In vitro comparison of Duraflo II heparin-coated and uncoated oxygenator circuits. J Thorac Cardiovasc Surg 1993; 106: 466-72.

12.

Edens RE , Linhardt RJ , Weiler JM Heparin is not just an anticoagulant anymore: six and one-half decades of studies on the ability of heparin to regulate complement activity. In: Cruse JM , Lewis RE eds. Complement today. Basel : Karger, 1993: 96-120.

13.

Øvrum E. , Holen EÅ , Tangen G. et al. Completely heparinized cardiopulmonary bypass and reduced systemic heparin: Clinical and hemostatic effects. Ann Thorac Surg 1995; 60: 365-71.

14.

von Segesser LK , Weiss BM , Garcia E. , Felten A. , Turina MI Reduction and elimination of systemic heparinization during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1992; 103: 790-99.