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J Thorac Cardiovasc Surg 1995;110:1633-1641
© 1995 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
Maastricht, The Netherlands
Received for publication Jan. 3, 1995. Accepted for publication April 12, 1995. Address for reprints: J. G.Maessen, MD, PhD, Department of Cardiothoracic Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Abstract
Cardiopulmonary bypass generates a systemic inflammatory response, including the activation of leukocytes, contributing to postoperative morbidity. To evaluate whether the use of heparin-treated extracorporeal circuits could reduce the inflammatory reaction in patients undergoing cardiopulmonary bypass, we conducted a prospective clinical study on 14 patients having coronary artery bypass in whom perfusion was done randomly with either Duraflo II heparin-treated circuits or with nontreated circuits. In both groups systemic heparinization was performed before cardiopulmonary bypass. The use of heparin-treated circuits resulted in a reduction of systemic inflammatory activation during cardiopulmonary bypass. This was reflected by lower plasma levels of soluble tumor necrosis factor receptors (p <0.05) and of interleukin-6 and interleukin-8 (p <0.05), manifest after release of the aortic crossclamp. Furthermore, 6 and 12 hours after aortic crossclamp release significantly lower levels of the soluble E-selectin (p <0.05) were observed in the Duraflo II group. In patients in whom noncoated circuits were used, a significant decrease in circulating soluble intercellular adhesion molecule 1 (p <0.05) was found early during bypass. All these observations suggest that the use of a heparin-treated extracorporeal circuit reduces the systemic inflammatory activation and may alter the leukocyte-endothelium interaction. (J THORAC CARDIOVASC SURG 1995;110:1633-41)
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