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The Annals of Thoracic Surgery, Vol 58, 421-424, Copyright © 1994 by The Society of Thoracic Surgeons
M Pekna, L Hagman, E Halden, UR Nilsson, B Nilsson and S Thelin
The role of complement in biocompatibility reactions and the correlation
between complement activation during cardiopulmonary bypass (CPB) and
postperfusion syndrome have inspired attempts to improve the
biocompatibility of extracorporeal blood oxygenation devices. Here we
assessed the effect of immobilized heparin on the generation of C3a and
terminal complement complexes during CPB. Thirty patients undergoing
aortocoronary bypass were randomized to CPB with either heparin-coated
(Duraflo II; Bentley, Irvine, CA) or noncoated control membrane oxygenators
(Univox; Bentley). A standard dose of heparin (300 IU/kg) was given to the
control group while the heparin dose was reduced to 30% (100 IU/kg) in the
heparin-coated group. Significantly lower levels of terminal complement
complexes were detected in the heparin-coated group by the end of CPB. From
28 +/- 5 AU/mL (heparin-coated group) and 26 +/- 3 AU/mL (control group,
mean +/- standard error of the mean) the terminal complement complex levels
increased to 391 +/- 35 AU/mL and 602 +/- 47 AU/mL, respectively (p <
0.002). This difference was still apparent 180 minutes after CPB. Although
there was no difference in C3a levels between the two groups at the end of
CPB, C3a levels were significantly lower in the heparin-coated group 30
minutes after CPB (194 +/- 18 ng/mL and 307 +/- 18 ng/mL in heparin-coated
and control groups, respectively; p < 0.001). We conclude that the
heparin-coated surface is more biocompatible with regard to complement
activation than is the ordinary unmodified surface in extracorporeal
circuits.
ARTICLES
Complement activation during cardiopulmonary bypass: effects of immobilized heparin
Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden.
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