Evaluation of the biocompatibility of four different types of oxygenator (bubble, membrane, hollow fibre and ‘hybrid’) was performed on 26 patients undergoing cardiopulmonary bypass during elective coronary surgery. More platelet derangement and an increased degree of hemolysis, revealed by higher plasmatic concentration of beta-thromboglobulin, platelet factor 4 and plasmatic free hemoglobin (p < 0.05), was seen when using the bubble oxygenator. Damage to blood cells was minimal with the membrane oxygenator while the ‘hybrid’ and the hollow fibre oxygenators proved to rank at an intermediate level. Complement activation at the beginning of the cardiopulmonary bypass occurred via the alternative pathway as demonstrated by C3adesarg increase (up to nine times) without a concomitant elevation of C4adesarg. Cardiopulmonary bypass complement activation was quantitatively similar with all the oxygenators. A further activation via the classical pathway occured in all the patients after protamine injection. Consistent differences as far as clinical and biological effects exist among the various commercially available cardiopulmonary bypass apparatus; our study provides guidelines for the evaluation and selection of devices which might reduce postoperative sequelae.
ArcidiJM, PowelsonSW, KingSBII, Trends in invasive treatment of single-vessel and double-vessel coronary disease. J Thor Cardiovasc Surg1988; 95: 773–81.
2.
SolenKA, WhiffenJD, LightfootEN. The effect of shear, specific surface, and air interface on the development of blood emboli and hemolysis. J Biomed Mater Res1978; 12: 381–99.
3.
Van OeverenW, KazatchkineMD, Descamps-LatschaB, Deleterious effects of cardiopulmonary bypass: a prospective study of bubble versus membrane oxygenation. J Thor Cardiovasc Surg1985; 89: 888–99.
4.
HanP, TurpieAGG, ButtR, LeblancP, GentonE, GunstensenS.The use of Beta-thromboglobulin release to assess platelet damage during C.P.B.P. Presented at the combined Meeting of the Royal Australasian College of Surgeons and Royal Australasian College of Physicians, Sydney, Australia, 1980; Feb. 24-9.
AddonizioVPJr, StraussJFIII, ColmanRW, EdmundsLHJr.Effects of prostaglandin E1 on platelets loss during in vivo and in vitro extracorporeal circulation with a bubble oxygenator. J Thor Cardiovasc Surg1979; 77: 119–26.
7.
EdmundsLHJr, SaxenaNC, HillyerP, WilsonTJ. Relationship between platelet count and cardiotomy suction return. Ann Thorac Surg1978; 25: 306–10.
8.
FriedenbergWR, MyersWO, PlotkaED, Platelet dysfunction associated with C.P.B.P. Ann Thorac Surg1978; 25: 298–305.
9.
HarkerLA, MalpassTW, BransonHE, HesselEAII, SlichterSJ. Mechanisms of abnormal bleeding in patients undergoing C.P.B.P.: Acquired transient platelet dysfunction associated with selective alpha-granule release. Blood1980; 56: 824–34.
10.
HammerschmidtDEE, StroncekDF, BowersTK, Complement activation and neutropenia occuring during cardiopulmonary bypass. J Thor Cardiovasc Surg1981; 81: 370–7.
11.
ChenowethDE, CooperSW, HugliTE, StewartRW, BlackstoneEH, KirklinJW. Complement activation during cardiopulmonary bypass: Evidence for generation of C3a and C5a anaphylatoxins. N Engl J Med1981; 304: 497–503.
12.
KirklinJK, WestabyS, BlackstoneEH, KirklinJW, ChenowethDE, PacificoAD. Complement and the damaging effects of cardiopulmonary bypass. J Thor Cardiovasc Surg1983; 86: 845–57.
13.
WysockyK, PonizynskyA, Wiarusz-WysockaB, BrockyZ, CzarneckiR.Cardiopulmonary bypass-induced complement activation: evidence for C5a participation. Int J Artif Organs1982; 5: 305–6.
14.
DawesJ, SmithRC, PepperDS. The release, distribution and clearance of human beta-thromboglobulin and platelet factor 4. Thromb Res1978; 12: 851–61.
15.
De CaterinaR, GazzettiP, MazzoneA, MarzilliM, L'AbbateA.Platelet activation in angina at rest. Evidence by paired measurement of plasma beta-thromboglobulin and platelet factor 4. Eur Heart J1988; 9: 913–22.
16.
HarboeM.A method for determination of hemoglobin in plasma by near ultraviolet spectrophotometry. Scand J Clin Lab Invest1959; 11: 66–70.
17.
WagnerJL, HugliTE. Radioimmunoassay for determining complement activation products in biological fluids. Ann Clin Biochem1984; 136: 75–88.
18.
WallensteinS, ZuckerCL, FleissJL. Some statistical methods useful in circulation research. Circ Res1980; 47: 1–9.
19.
WinerBS. Statistical principles in experimental design. GarmezyN, SolomonRL, JonesLV, StevensonHW, eds. 2nd ed. New York: McGraw-Hill, 1971.
20.
van den DungenJJAM, KarliczeckGF, BrenkenU, Homan van der HeideJN, WildewuurCRH. Clinical study of blood trauma during perfusion with membrane and bubble oxygenator. J Thor Cardiovasc Surg1982; 83: 108–16.
21.
LiddicoatJE, SzabolesMB, BeallAC, GlaeserDH, De BakeyME. Membrane versus bubble oxygenator. Clinical comparison. Ann Surg1975; 181: 747–53.
22.
SalamaA, HugoF, HeinrichD, HögeR, Deposition of terminal C5b-9 complement complexes on erythrocytes and leukocytes during cardiopulmonary bypass. N Engl J Med1988; 318: 408–14.
23.
BenedettiM, De CaterinaR, BiondaA, Bubble and membrane oxygenators: a comparative evaluation. Cah CECEC1988; 30: 303–11.
24.
KirklinJW, Barrat-BoyesBG. Hypothermia, circulatory arrest, and cardiopulmonary bypass. In: Cardiac Surgery. New York: Wiley J & Sons, 1986; 29–82.
25.
HesseE, FilatovA.Experimentelle Untersuchungen über das wesen des hämolytischen shocks bei der bluttransfusion und die therapeutische beeinflussung desselben. I. Die nierenfunktionsstörungen im akuten experiment. Ztschr f d ges exper Med1933; 86: 211.
26.
MillerJH, Mc DonaldRK. The effect of hemoglobin on renal function in the human. J Clin Invest1951; 30: 1033–40.
27.
CraddockPR, FehrJ, BrighamKL, KronenbergRS, JacobHS. Complement and leukocyte-mediated pulmonary dysfunction in hemodialysis. N Engl J Med1977; 296: 769–74.
28.
GardinaliM, CicardiM, AgostoniA, HugliTE. Complement activation in extracorporeal circulation: physiological and pathological implications. Pathol Immuno-pathol Res1986; 5: 352–70.
29.
NusbacherJ, RosenfeldSI, Mac PhersonJL, ThiemPA, LeddyJP. Nylon fibre leukapheresis-associated complement component changes and granulocytopenia. Blood1978; 51: 359–65.
30.
Mc LeodBC, ViernesA, SassettiRJ. Complement activation by plasma separation membranes. Transfusion1983; 23: 143–7.
31.
BiondaA, PallaR, PanichiR, Experimental evaluation of the hollow- fibre gas exchange for partial extracorporeal CO2 removal. In: SmebyLC, JorstadS, WideroeTE, eds. Immune and metabolic aspects of therapeutic blood perfusion system.Trondheim: KargerVerlag Press1986; 246–53.
MaggioreQ, EniaG, CatalanoC, MiserforiV, AntoninoM.Effects of blood cooling on Cuprophan-induced anaphylatoxin generation. Kidney Int1987; 32: 908–11.
34.
GhebrehiwetB, Müller EberhardHJ. C3e: an acidic fragment of an acidic fragment of human C3 with leukocytosis inducing activity. J Immunol1979; 123: 616–21.
35.
KajitaT, HugliTE. Leukocytosis induced by C5a. Complement and inflammation1989; 6: 353.
36.
QuirogaMM, MiyagishimaR, HaendschenLC, GlovskyM, MartinBA, HoggsJC. The effect of body temperature on leukocyte kinetics during cardiopulmonary bypass. J Thor Cardiovasc Surg1985; 90: 91–6.
37.
BoersM, van den DungenJJAM, KarliczeckGF, BrenkenU, Homan van der HeideJN, WilderwuurCRH. Two membrane oxygenators and a bubbler. A clinical comparison. Ann Thorac Surg1983; 35: 455–62.
CavarocchiNC, ShaffHV, OrszulakTA, HomburgerHA, SchnellWA, PluthJR. Evidence for complement activation by protamine heparin interaction after cardiopulmonary bypass. Surgery1985; 98: 525–30.
40.
BoralessaH, ShifferliJA, ZaimiF, WattsZ, WhitwamJG, ReeseJ.Perioperative changes in complement associated with cardiopulmonary bypass. Br J Anaesth1982; 54: 1047–52.
41.
ColletB, AlhaqA, AbdullahNB, Pathways to complement activation during cardiopulmonary bypass. Br Med j1984; 289: 1251–4.
42.
ChuJengChiuR, SamsonR.Complement (C3, C4) consumption in cardiopulmonary bypass, cardioplegia and protamine administration. Ann Thor Surg1984; 37: 229–32.
43.
CavarocchiNC, EnglandMD, HartzellMS, Oxygen free radical generation during cardiopulmonary bypass: correlation with complement activation. Circulation1986; 74 (suppl III): 130–3.
44.
KirklinJK, ChenowetDE, NaftelDC, Effects of protamine administration after cardiopulmonary bypass on complement, blood elements and the hemodynamic state. Ann Thorac Surg1986; 41: 193–9.
45.
ShapiraN, SchaffHV, PiehlerJM, WhiteRD, SillJC, PluthJR. Cardiovascular effects of protamine sulphate in man. J Thor Cardiovasc Surg1982; 84: 505–14.
46.
RentR, ErtelN.EisensteinR, GewurzH.Complement activation by interaction of polyanions and polycations. I Heparin-protamine induced consumption of complement. J Immunol (1 Pt1) 1975; 114: 120–4.
