Background: Pathophysiology of extracorporeal circulation is multifactorial, and the link between newly developed “biomaterials” and clinical outcome is not easy to illustrate. Material and methods: We designed a randomized, double-blinded, prospective study in order to verify the impact of a new surface modification [SMARXT] in combination with an optimized blood air interface, on the cerebral performance after cardiopulmonary bypass. 80 patients were randomly divided into two subgroups (SMARXT vs. standard PVC control) and analyzed for the kinetic of cerebral ischemia markers neuronspecific enolase, protein S100 and neuropsychologically tested with the Mini-Mental-Status Test (MMST) before and after the operation. Results: We could not show significant differences of protein S100 and neuron-specific enolase (NSE) levels between SMARXT patients and the controls, but the incidence of neurological complications was exceptionally low. Although no statistically significant differences could be obtained for the MMST, the different pointloss between both groups trends toward a better cerebral performance in SMARXT patients. Conclusion: The use of a biologically inert circuit in combination with an optimized perfusion management seems to be worthy of recommondation.
Key words:
SMARXT - Cardiopulmonary bypass - Biocompatibility - Protein S-100 - NSE
References
-
1 Isgro F, Kiessling A H, Saggau W. SMARXT and blood-air interface - a new concept to improve biocompatility of extracorporeal circuits. In Baykut D., Krian A. eds. Current Perspectives of the Extracorporeal Circulation. Darmstadt; D Steinkopff Verlag 2000: 77-83
-
2
Wachtvogel Y T, Harpel P C, Edmunds L H , Colman R W.
Formation of C1s-C1 inhibitor, kallikrein-C1- inhibitor and plasmin-alpha-2- plasmin-inhibitor complexes during cardiopulmonary bypass.
Blood.
1989;
73
468-471
-
3
Edmund L H .
Blood-surface- interactions during cardiopulmonary bypass.
J Cardiovasc Surg.
1989;
65
420-424
-
4
Loubser P G.
Effect of methylprednisolon on complement activation during helparin neutralization.
J Cardiovasc Pharmacol.
1997;
29
(1)
23-27
-
5
Daniel S.
Review of the multifactorial aspects of bioincompatibility in CPB.
Perfusion.
1996;
11
246-255
-
6
Kirklin J K.
Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass.
Ann Thorac Surg.
1991;
51
529-531
-
7
Fountain S W, Martin B A, Musclow C E, Cooper J D.
Pulmonary leucostasis and its relationship to pulmonary dysfunction in sheep and rabbits.
Circ Res.
1980;
46
175-180
-
8
Hornick P, George A.
Blood contact activation: pathophysiological effects and therapeutic approaches.
Perfusion.
1996;
11
3-19
-
9
Smith P L, Treasure T, Newman S P, Joseph P, Ell P J, Schneidau A, Harrison M J.
Cerebral consequences of cardiopulmonary bypass.
Lancet.
1986;
12
823-825
-
10
Kuroda Y, Uchimoto R, Kaieda R, Shinkura R, Shinohara K, Miyamoto S, Oshita S, Takcshita H.
Central nervous system complications after cardiac surgery: A comparison between coronary artery bypass grafting and valve surgery.
Anesth Analg.
1993;
76
222-227
-
11
Nussmeier N.
Neuropsychiatric complications after cardiac surgery.
J Cardiothorac Vasc Anesth.
1994;
8
13-16
-
12
Shaw P J, Bates D, Cartlige N E F, French J M, Heaviside D, Julian D G, Shaw D A.
Neurologic and neuropsychological morbidity following major surgery: Comparison of coronary artery bypass and peripheral vascular surgery.
Stroke.
1987;
18
700-707
-
13
Breuer A C, Furlan A, Hanson M R, Ledermann R J, Loop F D, Cosgrove D M, Greenstreet R L, Estafanous F G.
Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients.
Stroke.
1983;
14
682-687
-
14
Johnson P, Lundquist C, Lindgren A, Ferencz I, Alling C, Stahl E.
Cerebral complications after cardiac surgery assessed by S100 and NSE levels in blood.
Cardiothorac Vasc Anesth.
1995;
6
694-699
-
15
Taggart D P, Mazel J W, Bhattacharya K, Meston N, Standing S J, Kay J D S, Pillai R, Johnsson P, Westaby S.
Comparison of Serum S100 levels during CABG and intracardiac operations.
Ann Thorac Surg.
1997;
63
492-496
-
16
Blomquist S, Johnsson P, Lührs C, Malmkvist G, Solem J O, Alling C, Stahl E.
The Appearance of S100-Protein in serum during and immediately after cardiopulmonary bypass surgery: A possible marker for cerebral injury.
J Cardiothorac Vasc Anaesth.
1997;
6
699-703
-
17
Isgro F, Schmidt Ch, Pohl P, Saggau W.
A predictive parameter in patients with brain related complications after cardiac surgery.
Eur J Cardiothorac Surg.
1997;
11
640-644
-
18
Folstein M F, Folstein S E, McHugh P R.
Mini Mental State: A practical method for grading the cognitive state of patients for the clinician.
J Psychiat Res.
1975;
12
189-198
-
19
Waterloo K, Ingebrigsten T, Rommer B.
Neuropsychological function in patients with increased serum levels of protein S100 after minor head injury.
Acta Neurochir.
1997;
139
26-32
-
20
Wimmer-Greinecker G, Matheis G, Martens S, Oremek G, Abdel-Rhaman U, Moritz A.
Synthetic protein treated versus heparin coated cardiopulmonary bypass surfaces: similar clinical results and minor biochemical differences.
Eur J Cardiothorac Surg.
1999;
16
211-217
-
21 Nyberg L, Kroon R, Ullen A, Brundell J, Haglid K G, Stigbrand T. Sangtec LIA a sensitive monoclonal assay for measuring protein S100 bin serum samples. Abstract 10th Int. Symposium on Calcium-binding-proteins and calcium function in health and disease. Lund 1997
-
22
Brooker R F, Brown W R, Moody D M, Hammon J W, Reboussin D M, Deal D D, Ghazi-Birry H S, Stump D A.
Cardiotomy Suction: A major source of brain lipid emboli during cardiopulmonary bypass.
Ann Thorac Surg.
1998;
66
1651-1655
-
23 Möhnle P, Nollert G, Tassani-Prell P, Borasio G D, Schmöckel M, Reichard B. Cerebral hypoxia diagnosed by intraoperative near infrared spectophotometry. Measurement correlates with postoperative neuropsychological defects in cardiac surgery. 22. Symposium on advanced physiological monitoring. München; 1994
1 The paper has been presented at the meeting ofThe Austrian, German and Swiss Society for Thoracic and Cardiovascular Surgery in Lucerne, Suisse, 02/1 1/2000
M.D. Frank Isgro
Klinik für Herzchirurgie, Herzzentrum Ludwigshafen
Bremserstraße 73
67063 Ludwigshafen
Germany
Telefon: +49 621 503 4050
Fax: +49 621 503 4060
eMail: isgrof@klilu.de
