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Heparin coating and cardiotomy suction in cardiopulmonary bypass
Umeå University, Faculty of Arts, Archaeology and Sami Studies.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The present thesis addresses various means of reducing inflammatory responses associated with cardiopulmonary bypass (CPB) and retransfusion of pericardial suction blood (PSB) during cardiac surgery.

Four (I-IV) prospective randomised controlled clinical trials comprising 475 patients were performed in the following areas: effects of heparin coating on measures of clinical outcome and memory function (I, II), inflammatory reactions in PSB and its systemic effects after retransfusion using cardiotomy suction or cell salvage (III) and effects of retransfusion of PSB on memory function and release patterns of protein S100B (IV).

The use of heparin coated CPB-circuits was associated with a decrease of postoperative blood loss (I, II), transfusion requirements (II), shorter stay in hospital (I) decreased postoperative ventilator time (I), lower incidences of atrial fibrillation (II) and neurological deviations (I), reduction in releases of protein S100B (I, II) and lower postoperative creatinine elevation (I, II).

PSB contained high concentrations of cytokines, complements, myeloperoxidase, free plasma haemoglobin and protein S100B (III, IV). Retransfusion using cardiotomy suction increased the systemic concentrations of free plasma haemoglobin and protein S100B, whereas retransfusion using cell salvage caused no detectable systemic effects (III, IV). CPB was associated with a small but significant release of protein S100B, despite elimination of PSB-contained protein S100B using cell salvage (IV).

Subtle signs of impaired memory function were identified that were not associated with the use of heparin coated CPB-circuits (I, II) or retransfusion of PSB (IV).

Key words: cardiopulmonary bypass, oxygenators, heparin, S100 proteins, blood loss, haemostasis, memory, outcome and process assessment.

Place, publisher, year, edition, pages
2003. , 71 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 855
Keyword [en]
Surgery, cardiopulmonary bypass, oxygenators, heparin, S100 proteins, blood loss, haemostasis, memory, outcome and process assessment
Keyword [sv]
Kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-134ISBN: 91-7305-523-9 (print)OAI: oai:DiVA.org:umu-134DiVA: diva2:140699
Public defence
2003-11-21, Aulan, Administrationsbyggnaden, Norrlands Universitetssjukhus, Umeå, 13:00
Opponent
Supervisors
Available from: 2003-10-22 Created: 2003-10-22 Last updated: 2012-06-28Bibliographically approved
List of papers
1. Clinical effects of the heparin coated surface in cardiopulmonary bypass
Open this publication in new window or tab >>Clinical effects of the heparin coated surface in cardiopulmonary bypass
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1997 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 11, no 5, 957-964 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: In a randomised study of 120 patients, undergoing primary operation for coronary heart decease, two groups were investigated as regards to the effects of heparin coated cardiopulmonary bypass on brainfunction parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with covalent bonded heparin; the control group (n = 59) used an identical set-up without heparin treatment. Systemic heparin doses were calculated to achieve ACT levels of 250 and 500 s, respectively. Postoperative course was evaluatedby examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain function was assessed by the biochemical marker S-100 and tests of memory performance.

RESULTS: There were several signs of reduced operative trauma in the study group. Hospital stay was reduced by nearly 1 day (P < 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was significantly reduced (P = 0.03). Neurological deviations were fewer (P =0.01). Brain function assessment revealed reduced plasma levels of S- 100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P= 0.04). However, no remediation of memory impairment could be demonstrated.

CONCLUSIONS: Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively the operative stress to the patient. There were also signs of improved cerebral protection.

Place, publisher, year, edition, pages
Oxford University Press, 1997
Keyword
cardiopulmonary bypass, heparin, biocompatible materials, thoracic surgery, memory, nerve tissue protein S-100
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:umu:diva-2524 (URN)10.1016/S1010-7940(97)88351-0 (DOI)A1997XE01800042 ()
Available from: 2003-10-22 Created: 2003-10-22 Last updated: 2017-12-14Bibliographically approved
2. Neurological and general outcome in low-risk coronary artery bypass patients using heparin coated circuits
Open this publication in new window or tab >>Neurological and general outcome in low-risk coronary artery bypass patients using heparin coated circuits
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2001 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 19, no 1, 47-53 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The clinical significance of heparin coating in cardiopulmonary bypass has previously been investigated. However, few studies have addressed the possible influence on brain function and memory disturbances.

Methods: Three hundred low-risk patients exposed to coronary bypass surgery were randomised into three groups according to type of heparin coating: Carmeda Bioactive Surface, Baxter Duraflo II and a control group. Outcome was determined from a number of clinically oriented parameters, including a detailed registry of postoperative deviations from the normal postoperative course. Brain damage was assessed through S100 release and memory tests, including a questionnaire follow-up.

Results: Clinical outcome was similar for all groups. Blood loss (Duraflo only), transfusion requirements and postoperative creatinine elevation were reduced in the heparin-coated groups. A lower incidence of atrial fibrillation was noted in the Duraflo group. Heparin coating did not uniformly attenuate the release of S100 or the degree of memory impairment.

Conclusions: Cardiopulmonary bypass (CPB) with heparin coating and a reduced dose of heparin seems to be safe. Clinical outcome and neurological injury seem not to be associated with type of heparin coating used for CPB. However, blood loss and transfusion requirements may be reduced.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2001
Keyword
Amnesia/etiology, Blood Loss, Surgical/physiopathology, Blood Transfusion, Brain Damage, Chronic/etiology, Cardiopulmonary Bypass/*instrumentation, *Coated Materials, Biocompatible, Coronary Artery Bypass/*instrumentation, Female, *Heparin, Humans, Male, Middle Aged, *Neurologic Examination, Neuropsychological Tests, Postoperative Complications/*etiology, Prospective Studies, Risk Factors, S100 Proteins/blood
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-31421 (URN)10.1016/S1010-7940(00)00625-4 (DOI)1010-7940 (Print) (ISBN)
Available from: 2010-02-10 Created: 2010-02-10 Last updated: 2017-12-12
3. The inflammatory response to recycled pericardial suction blood and the influence of cell saving
Open this publication in new window or tab >>The inflammatory response to recycled pericardial suction blood and the influence of cell saving
2003 In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 37, no 3, 158-164 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2526 (URN)
Available from: 2003-10-22 Created: 2003-10-22Bibliographically approved
4. Influence of pericardial suction blood retransfusion on memory function and release of protein S100B
Open this publication in new window or tab >>Influence of pericardial suction blood retransfusion on memory function and release of protein S100B
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(English)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-2527 (URN)
Available from: 2003-10-22 Created: 2003-10-22 Last updated: 2010-03-03Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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  • de-DE
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  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
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