Does the Additional Use of Heparin-Coated Extracorporeal Circuits (ECC) Optimize the Effect of Modified Ultrafiltration (MUF) in Pediatric Perfusion?[1]

Abstract

Background: Modified ultrafiltration (MUF) has been shown to exert beneficial effects on the coagulation system and the capillary leak after pediatric cardiac surgery using extracorporeal circulation (ECC). The aim of this study was to investigate whether the additional use of heparin-coated circuits is a useful option for improving biocompatibility. Methods: We randomized 28 children, using heparin-coated ECC circuits in group A (n = 14) and an uncoated equivalent set in group B (n = 14). After congenital heart surgery, MUF was performed post ECC in a standardized fashion. Blood samples were analyzed preoperatively, 10 min, 30 min, 1 h, and 48 h after ECC by flow cytometric analysis (FACSort) using surface antigens CD62/CD41b (platelets) and CD45/CD14 (monocytes). Results: No significant difference was found with respect to mean age (20.6 months vs. 21.6 months), mean body weight (9.2 kg vs. 8.4 kg), mean ultrafiltration rate (9.1 ml/kg vs. 11.4 ml/kg), chest tube drainage, blood products, ICU stay, and 30-d survival. The percentage of CD62/CD41-positive platelets in group A (vs. B) increased up to 118 % at 60 min vs. 130 % (p < 0.05) and declined to 98 % at 48 h postop. vs. 99 % (n. s.). The percentage of CD45/CD14-positive monocytes in group A (vs. B) increased up to 158 % at 60 min vs. 155 % (n. s.) and declined to 122 % (A) at 48 h postop. vs. 61 % (B) (p > 0.05). Conclusions: Heparin coating of ECC in addition to MUF leads to a lower platelet activation. Monocyte surface markers CD45 and CD14 indicated a marked activation during ECC in both groups but additional heparin coating showed a better postoperative regeneration of monocyte markers in the late course indicating a beneficial additive effect.

Modified ultrafiltration - heparin coating - pediatric cardiac surgery

References

• 1 Kirklin J K, Westaby S, Blackstone E H, Kirklin J W, Chenoweth D E, Pacifico A D. Complement and damaging effects of cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1983;  86 845-857
• 2 Butler J, Rocker G M, Westaby S. Inflammatory response to cardiopulmonary bypass.  Ann Thorac Surg. 1993;  55 552-559
• 3 Casey L C. Role of cytokines in the pathogenesis of cardiopulmonary-induced multisystem organ failure.  Ann Thorac Surg. 1993;  56 92-96
• 4 Taylor K M. SIRS - The systemic inflammatory response syndrome after cardiac operations.  Ann Thorac Surg. 1996;  61 1607-1608
• 5 Naik S K, Knight A, Elliott M J. A successful modification of ultrafiltration for cardiopulmonary bypass in children.  Perfusion. 1991;  6 41-50
• 6 Elliott M J. Ultrafiltration and modified ultrafiltration in pediatric open heart operations.  Ann Thorac Surg. 1993;  56 1518-1522
• 7 Davies M J, Nguyen K, Gaynor J W, Elliott M J. Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1998;  115 361-370
• 8 Dagget C W, Lodge A J, Scarborough J E, Chai P J, Jaggers J, Ungerleider R M. Modified ultrafiltration versus conventional ultrafiltration: a randomized prospective study in neonatal piglets.  J Thorac Cardiovasc Surg. 1998;  115 336-342
• 9 Ungerleider R M. Effects of cardiopulmonary bypass and use of modified ultrafiltration.  Ann Thorac Surg. 1998;  65 35-39
• 10 Boyle Jr E M, Pohlman T H, Johnson M C, Verrier E D. The systemic inflammatory response.  Ann Thorac Surg. 1997;  64 31-37
• 11 Muench F, Vestweber-Wilmes E, Bretzger J, Hakami L, Weyand M, Cesnjevar R. “MUF deLuxe”- Erlanger Verfahren der modifizierten Ultrafiltration.  Kardiotechnik. 2003;  4 138-141
• 12 Feyrer R, Blum U, Disput A, Katalinic E A, von der Emde J. Heparin coating of extracorporeal circuits reduces neuropsychologic dysfunction after Cardiac Surgery.  Thorac Cardiov Surg. 1997;  45 (Suppl I) 65
• 13 Harig F, Hohenstein B, von der Emde J. et al . Immunomonitoring during and after CPB for analysis of cytokine secretion patterns and developing of a preventive strategy of SIRS after cardiac surgery.  Thorac Cardiov Surg. 1997;  45 (Suppl I) 65 138
• 14 Cremer J, Haverich A, Borst H G. et al . Systemic inflammatory response after cardiac operations.  Ann Thorac Surg. 1996;  61 1714-1720
• 15 Gruenenfelder J, Zuend G, Turina M. et al . Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass.  Eur J Cardiothorac Surg. 2000;  17 77-83
• 16 Harig F, Hohenstein B, von der Emde J, Weyand M. Modulating IL‐6 and IL‐10 levels by pharmacologic strategies and the impact of different extracorporeal circulation parameters during cardiac surgery.  Shock. 2001;  16 (Suppl 1) 33-38
• 17 Harig F, Feyrer R, Mahmoud F O, Blum U, von der Emde J. Reducing the post-pump syndrome by using heparin-coated circuits, steroids, or aprotinin.  Thorac Cardiovasc Surg. 1999;  47 111-118
• 18 Svenmarker S, Haggmark S, Jansson E, Lindholm R, Appelblad M, Sandstrom E, Aberg T. Use of heparin-bonded circuits in cardiopulmonary bypass improves clinical outcome.  Scand Cardiovasc J. 2002;  36 241-246
• 19 Flom-Halvorsen H I, Ovrum E, Brosstad F, Tangen G, Ringdal M, Oystese R. Effects of two differently heparin-coated extracorporeal circuits on markers for brain and myocardial dysfunction.  Perfusion. 2002;  17 339-345
• 20 Sbrana S, Bevilacqua S, Buffa M, Spiller D, Parri M S, Gianetti J, de Filippis R, Clericio A. Post-reperfusion changes of monocyte function in coronary blood after extracorporeal circulation.  Cytometry Part B (Clinical Cytometry). 2005;  65 B 14-21

1 Presented at the 34th Meeting of the German Society for Thoracic and Cardiovascular Surgery, Hamburg, February 13 - 16, 2005.