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Improved Safety Of Cardiopulmonary Bypass With The Use Of Thrombo-Resistant Surfaces In Closed Perfusion Systems
Bader E Hussaini, Hemant S Thatte, Patrick R Treanor, Xui-Gui Lu, Shukri F Khuri
Boston VA Healthcare system, West Roxbury, MA
1. Objective Compare heparin-bonded CPB circuits in a closed perfusion system (HBC-C) to commonly employed non-heparin bonded CPB circuits in an open perfusion system (NHBC-O)
2. Design Randomized open-chest animal study. Student t test and a generalized estimated equations (GEE) approach were used to estimate parameters and test differences between two groups.
3. Setting Simulation of clinical CPB surgery.
4. Subjects Pigs
5. Intervention 24 animals were subjected to CPB for 3 hours and monitored for 1 hour post CPB. HBC-C and NHBC-O in 2 groups of 10 pigs received heparin in a similar dose; 2 pigs received saline with no anticoagulation in each group.
6. Main Outcome Measured Clinical, hemodynamic, hematology, biochemistry, pathology and imaging variables were quantified temporally during the experiment.
7. Results Pigs in HBC-C showed 43.5 % reduction in post-CPB blood loss (357.6±85.3 vs. 632.6±173.9 ml, p=0.0006). The NHBC-O group exhibited 32.7 % post-CPB decrease in platelets (294.1 vs. 197.81, p<0.0001), significant increases in ALA, AST and CPK enzymes compared to HBC-C group (33.3±2.5 vs. 25.4±1.6 u/l, p 0.0202; 103.8±12.4 vs. 65.3±2.8 u/l, p0.0015; 3471.5±282.6 vs. 1141.9±112.8 u/l, p<0.0001 respectively). Calcium dye and fluorescence imaging revealed WBC and platelets trapping in the arterial filter in NHBC-O group. Imaging studies demonstrated reduced WBC, increased granulocytes and calcium mobilization in NHBC-O group.
8. Conclusion Non-thromboresitant circuits in open perfusion systems, used in cardiac surgery today have adverse clinical, hematologic and pro-inflammatory effects that can be ameliorated by use of heparin-coated circuits and closed perfusion systems.
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