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Active or passive bio-coating : does it matters in extracorporeal circulation?

S Jacobs, Filip De Somer (UGent) , GUY VANDENPLAS (UGent) , Yves Van Belleghem (UGent) , Yvo Taeymans (UGent) and Guido Van Nooten (UGent)
(2011) PERFUSION-UK. 26(6). p.496-502
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Abstract
Background: Two types of surface coating for cardiopulmonary bypass (CPB) are used: bioactive (heparin, nitric oxide) and biopassive (albumin, polyethyleneoxide (PEO), phosphorylcholine). When haemocompatible coatings are combined with the separation of pleuro-pericardial aspiration, attenuation of both the coagulation and complement cascades, as well as better platelet preservation, has been demonstrated. This study wants to investigate if the combination of a bioactive with a biopassive coating (unfractionated heparin embedded in a phosphorylcholine matrix) combines the beneficial effects of both approaches. Materials and methods: Thirty patients undergoing elective CABG were prospectively randomized into two groups of 15 patients. The sole exclusion criterion was an ejection fraction of less than 40%. In the control group (PC), the whole CPB circuit was coated with phosphorylcholine (PC). In the study group (XPC), unfractionated heparin was embedded in the PC matrix of the oxygenator and arterial line filter. Results: No differences were found for haemolytic index, thrombin-anti-thrombin complex (TAT), IL-6, IL-10 and blood loss. PF4 plasma concentration increased from 27.6 +/- 22.0 IU/mL to 165.7 +/- 43.9 IU/mL (p < 0.001) at 15 minutes of CPB in the PC and from 16.0 +/- 9.7 IU/mL to 150.9 +/- 61.3 IU/mL (p < 0.001) in the XPC group. Terminal complement complex (TCC) increased over time in both groups until the end of CPB (Figure 2A). Within each group, TCC generation was statistically significantly higher after the release of the aortic cross-clamp (p < 0.001) and at the end of CPB (p < 0.001). Total TCC generation was statistically significantly higher in the XPC group compared to the PC group (p=0.026). The difference was statistically significant after the release of the aortic cross-clamp (p=0.005) and at the end of CPB (p=0.001). Conclusions: Based on our results, there is no additional benefit in combining phosphorylcholine with unfractionated heparin in elective patients undergoing coronary artery bypass grafting (CABG). Massive haemodilution leads to enhanced complement activation.
Keywords
phosphorylcholine, OUTCOMES, cardiopulmonary bypass, CABG, heparin, inflammatory response, CARDIOPULMONARY BYPASS, HEMODILUTIONAL ANEMIA, CARDIAC-SURGERY, ACTIVATION, LOW HEMATOCRIT, HEMOLYSIS, CIRCUITS, THROMBIN, ADULT

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Chicago
Jacobs, S, Filip De Somer, GUY VANDENPLAS, Yves Van Belleghem, Yvo Taeymans, and Guido Van Nooten. 2011. “Active or Passive Bio-coating : Does It Matters in Extracorporeal Circulation?” Perfusion-uk 26 (6): 496–502.
APA
Jacobs, S, De Somer, F., VANDENPLAS, G., Van Belleghem, Y., Taeymans, Y., & Van Nooten, G. (2011). Active or passive bio-coating : does it matters in extracorporeal circulation? PERFUSION-UK, 26(6), 496–502.
Vancouver
1.
Jacobs S, De Somer F, VANDENPLAS G, Van Belleghem Y, Taeymans Y, Van Nooten G. Active or passive bio-coating : does it matters in extracorporeal circulation? PERFUSION-UK. 2011;26(6):496–502.
MLA
Jacobs, S, Filip De Somer, GUY VANDENPLAS, et al. “Active or Passive Bio-coating : Does It Matters in Extracorporeal Circulation?” PERFUSION-UK 26.6 (2011): 496–502. Print.
@article{2006776,
  abstract     = {Background: Two types of surface coating for cardiopulmonary bypass (CPB) are used: bioactive (heparin, nitric oxide) and biopassive (albumin, polyethyleneoxide (PEO), phosphorylcholine). When haemocompatible coatings are combined with the separation of pleuro-pericardial aspiration, attenuation of both the coagulation and complement cascades, as well as better platelet preservation, has been demonstrated. This study wants to investigate if the combination of a bioactive with a biopassive coating (unfractionated heparin embedded in a phosphorylcholine matrix) combines the beneficial effects of both approaches. 
Materials and methods: Thirty patients undergoing elective CABG were prospectively randomized into two groups of 15 patients. The sole exclusion criterion was an ejection fraction of less than 40%. In the control group (PC), the whole CPB circuit was coated with phosphorylcholine (PC). In the study group (XPC), unfractionated heparin was embedded in the PC matrix of the oxygenator and arterial line filter. 
Results: No differences were found for haemolytic index, thrombin-anti-thrombin complex (TAT), IL-6, IL-10 and blood loss. PF4 plasma concentration increased from 27.6 +/- 22.0 IU/mL to 165.7 +/- 43.9 IU/mL (p < 0.001) at 15 minutes of CPB in the PC and from 16.0 +/- 9.7 IU/mL to 150.9 +/- 61.3 IU/mL (p < 0.001) in the XPC group. Terminal complement complex (TCC) increased over time in both groups until the end of CPB (Figure 2A). Within each group, TCC generation was statistically significantly higher after the release of the aortic cross-clamp (p < 0.001) and at the end of CPB (p < 0.001). Total TCC generation was statistically significantly higher in the XPC group compared to the PC group (p=0.026). The difference was statistically significant after the release of the aortic cross-clamp (p=0.005) and at the end of CPB (p=0.001). 
Conclusions: Based on our results, there is no additional benefit in combining phosphorylcholine with unfractionated heparin in elective patients undergoing coronary artery bypass grafting (CABG). Massive haemodilution leads to enhanced complement activation.},
  author       = {Jacobs, S and De Somer, Filip and VANDENPLAS, GUY and Van Belleghem, Yves and Taeymans, Yvo and Van Nooten, Guido},
  issn         = {0267-6591},
  journal      = {PERFUSION-UK},
  keywords     = {phosphorylcholine,OUTCOMES,cardiopulmonary bypass,CABG,heparin,inflammatory response,CARDIOPULMONARY BYPASS,HEMODILUTIONAL ANEMIA,CARDIAC-SURGERY,ACTIVATION,LOW HEMATOCRIT,HEMOLYSIS,CIRCUITS,THROMBIN,ADULT},
  language     = {eng},
  number       = {6},
  pages        = {496--502},
  title        = {Active or passive bio-coating : does it matters in extracorporeal circulation?},
  url          = {http://dx.doi.org/10.1177/0267659111415146},
  volume       = {26},
  year         = {2011},
}

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