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The Impact of Heparin-Coated Cardiopulmonary Bypass Circuits on Pulmonary Function and the Release of Inflammatory Mediators

The Impact of Heparin-Coated Cardiopulmonary Bypass Circuits on Pulmonary Function and the Release of Inflammatory Mediators,10.1213/01.ANE.0000114551

The Impact of Heparin-Coated Cardiopulmonary Bypass Circuits on Pulmonary Function and the Release of Inflammatory Mediators   (Citations: 21)
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Reduction of the inflammatory reaction with the use of heparin coating has been found during and after car- diopulmonary bypass (CPB). The question remains whether this reduced reaction also decreases the mag- nitude of CPB-induced pulmonary dysfunction. We therefore evaluated the effects of a heparin-coated cir- cuit versus a similar uncoated circuit on pulmonary in- dices as well as on inflammatory markers of comple- ment activation (C3b/c), elastase-1-antitrypsin complex, and secretory phospholipase A2 (sPLA2) dur- ing and after CPB. Fifty-one patients were randomly assigned into two groups undergoing coronary artery bypass grafting with either a heparin-coated (Group 1) or an uncoated (Group 2) circuit. During CPB, a contin- uous positive airway pressure of 5 cm H2O and a frac- tion of inspired oxygen (Fio2) of 0.21 were maintained. Differences in favor of the coated circuit were found in
Journal: Anesthesia and Analgesia - ANESTH ANALG , vol. 99, no. 3, pp. 1586-1594, 2004
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    • ...Hence, the main beneficial effects of heparincoated circuits are considered to be the following two: first, a reduction of complement activation (and mainly of factor C5a) ranging between 25% and 45% [29,30], and second, a reduction of the inflammatory reaction which is thought to be accomplished in two ways: through a reduction of complement activation, and through binding of phospholipase A2 [31]...
    • ...Heparin reduces the inflammatory responses especially as far as the actions of platelets, leukocytes, and endothelial cells are concerned [31-34]...
    • ...This effect is noticeable by a decreased production of IL-6, IL-8, E-selectin, lactoferin, myeloperoxidase, integrin, selectin, and platelet bthromboglobulin release, and reduced production of oxygen free radicals, as well [31-34]...
    • ...De Vroege et al [31] demonstrated comparatively significant postoperative differences in favour of the patients treated with heparin-coated circuits in terms of the pulmonary shunt fraction, the pulmonary...
    • ...In addition, they found reduced activation of pulmonary capillary endothelial cells in the same group of patients, suggesting that the heparincoated circuit may have beneficial effects on pulmonary function [31]...
    • ...However, most clinical studies have shown, that these beneficial effects did not influence the intubation-time or the ICU-stay of patients [31,37,38]...

    Efstratios E Apostolakiset al. Strategies to prevent intraoperative lung injury during cardiopulmonar...

    • ...IL-10 levels, as an anti-inflammatory cytokine, increases after elevated pro-inflammatory cytokine levels for representing an endogenous response for limiting the inflammatory response (24)...

    D. Kılıçet al. Clinical efficacy of leukofiltration on cardiopulmonary bypass related...

    • ...CPB triggers a significant inflammatory response in heart surgery [18,19], with significantly fewer consequences when the CPB duration is less than 70 minutes [20]...

    Fábio Papa TANIGUCHIet al. Cardiopulmonary bypass time as a risk factor for acute renal failure

    • ...One report further demonstrates that patients exposed to heparincoated circuits have a decreased inflammatory response, reduced pulmonary vascular resistance, and improved Pao2/Fio2 ratios after surgery; however, this was not associated with a decreased lung ventilation time or intensive care unit stay (12)...

    Ravi Tanejaet al. Con: Heparin-Bonded Cardiopulmonary Bypass Circuits Should Be Routine ...

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