Clinical evaluation of totally heparin-coated cardiopulmonary bypass circuits on coagulation, fibrinolysis, platelets, and complement system
To assess the biocompatibility of covalently-bonded, heparin-coated, cardiopulmonary bypass circuits (CPB), we compared a control CPB group (C group) with a heparin-coated CPB (H group) in elective CABG operations. Method: Fourteen patients who underwent CABG were randomly divided between the C grou...
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| Published in | Jinko Zoki Vol. 26; no. 6; pp. 990 - 996 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
JAPANESE SOCIETY FOR ARTIFICIAL ORGANS
1997
一般社団法人 日本人工臓器学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-0818 1883-6097 |
| DOI | 10.11392/jsao1972.26.990 |
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| Abstract | To assess the biocompatibility of covalently-bonded, heparin-coated, cardiopulmonary bypass circuits (CPB), we compared a control CPB group (C group) with a heparin-coated CPB (H group) in elective CABG operations. Method: Fourteen patients who underwent CABG were randomly divided between the C group (n=7) and the H group (n=7). The CPB circuits included a membrane oxygenator (Maxima) and a centrifugal pump (Biopump). In the H group, heparin (3mg/kg) was administered to maintain an activated clotting time (ACT) greater than 480s. Measurements of blood samples were taken both preoperatively and during CPB to assess the values of the following: thrombin-antithrombin III complex (TAT), fibrinogen, antithrombin (AT)-III, plasminogen activator inhibitor-1 (PAT-1), α2-plasmin inhibitor plasmin complex (PIC), fibrinogen degradation product (FDP), fibrinopeptide Bβ15-42, C3, C4, β-thromboglobulin, platelet factor IV, 6-keto-PGF1β, thromboxane B2, myeloperoxidase, and free hemoglobin. Also, morphologic examinations of platelets on the surface of CPB circuits were performed, using a scanning electron microscope (SEM). Results: Compared with the C group, the H group showed significant suppression of the titers in TAT and PAT-1 (p<0.013 and p<0.019, respectively). The SEM survey also revealed significant suppression of morphologic changes in surfaceadhesive platelets in the H group. Conclusions: Considering biocompatibility in open heart surgery, some values of coagulation, fibrinolysis, and platelet activation were found to be preferable in heparin-coated CPB. |
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| AbstractList | To assess the biocompatibility of covalently-bonded, heparin-coated, cardiopulmonary bypass circuits (CPB), we compared a control CPB group (C group) with a heparin-coated CPB (H group) in elective CABG operations. Method: Fourteen patients who underwent CABG were randomly divided between the C group (n=7) and the H group (n=7). The CPB circuits included a membrane oxygenator (Maxima) and a centrifugal pump (Biopump). In the H group, heparin (3mg/kg) was administered to maintain an activated clotting time (ACT) greater than 480s. Measurements of blood samples were taken both preoperatively and during CPB to assess the values of the following: thrombin-antithrombin III complex (TAT), fibrinogen, antithrombin (AT)-III, plasminogen activator inhibitor-1 (PAT-1), α2-plasmin inhibitor plasmin complex (PIC), fibrinogen degradation product (FDP), fibrinopeptide Bβ15-42, C3, C4, β-thromboglobulin, platelet factor IV, 6-keto-PGF1β, thromboxane B2, myeloperoxidase, and free hemoglobin. Also, morphologic examinations of platelets on the surface of CPB circuits were performed, using a scanning electron microscope (SEM). Results: Compared with the C group, the H group showed significant suppression of the titers in TAT and PAT-1 (p<0.013 and p<0.019, respectively). The SEM survey also revealed significant suppression of morphologic changes in surfaceadhesive platelets in the H group. Conclusions: Considering biocompatibility in open heart surgery, some values of coagulation, fibrinolysis, and platelet activation were found to be preferable in heparin-coated CPB.
従来の人工心肺回路においては, 異物である人工肺および体外循環回路表面との接触により凝固線溶系・補体系・白血球・血小板が活性化される. 今回, 著者らは全回路をヘパリンコーティングした体外循環を施行し, 生体適合性をコントロール群と比較検討した. ヘパリンコーティング群7例, コントロール群7例を対象とし, ヘパリン投与前, 体外循環開始直後, 30分後, 60分後, 90分後のガス交換能, 血球系, 凝固系, 線溶系, 補体系, 血小板系, 遊離ヘモグロビンをそれぞれ比較した. また, 体外循環終了後, 人工肺・血液フィルタ・除泡材を電子顕微鏡で観察し, その血小板付着程度と形態変化をスコアー化することで両群を比較した. ヘパリンコーティング群では, プラスミノゲンアクチベータインヒビター1とトロンビンアンチトロンビンーIII複合体が有意に産生抑制されていることと, 電顕所見からも有意に血小板形態変化が抑制されていることが認められた. To assess the biocompatibility of covalently-bonded, heparin-coated, cardiopulmonary bypass circuits (CPB), we compared a control CPB group (C group) with a heparin-coated CPB (H group) in elective CABG operations. Method: Fourteen patients who underwent CABG were randomly divided between the C group (n=7) and the H group (n=7). The CPB circuits included a membrane oxygenator (Maxima) and a centrifugal pump (Biopump). In the H group, heparin (3mg/kg) was administered to maintain an activated clotting time (ACT) greater than 480s. Measurements of blood samples were taken both preoperatively and during CPB to assess the values of the following: thrombin-antithrombin III complex (TAT), fibrinogen, antithrombin (AT)-III, plasminogen activator inhibitor-1 (PAT-1), α2-plasmin inhibitor plasmin complex (PIC), fibrinogen degradation product (FDP), fibrinopeptide Bβ15-42, C3, C4, β-thromboglobulin, platelet factor IV, 6-keto-PGF1β, thromboxane B2, myeloperoxidase, and free hemoglobin. Also, morphologic examinations of platelets on the surface of CPB circuits were performed, using a scanning electron microscope (SEM). Results: Compared with the C group, the H group showed significant suppression of the titers in TAT and PAT-1 (p<0.013 and p<0.019, respectively). The SEM survey also revealed significant suppression of morphologic changes in surfaceadhesive platelets in the H group. Conclusions: Considering biocompatibility in open heart surgery, some values of coagulation, fibrinolysis, and platelet activation were found to be preferable in heparin-coated CPB. |
| Author | KOKUBO, J |
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| References | 13) Gott VL, Whiffen JD, Dutton RC: Heparin bonding on colloidal graphite surfaces. Science 142: 1297, 1963 6) 宮本裕治: 人工心肺下体外循環中の血中補体活性化に関する臨床的検討. 日胸外会誌 34: 2055, 1986 7) Gorman RC, Ziats N, Rao AK, Gikakis N, Sun L, Khan MM, Stenach N, Sapatnekar S, Chouhan V, Gorman J, Niewiarowski S, Colman RW, Anderson JM, Edmunds L Jr: Surface-bound heparin fails to reduce thrombin formation during clinical cardiopulmonary bypass. J Thorac Cardiovasc Surg 111: 1, 1996 9) 井手博文, 藤木達雄, 小石沢正, 渡邊寛, 江上純, 林信成, 相崎雅弘, 小久保純, 野中健史, 戸成邦彦, 笹川成, 本田克彦, 有村康夫, 池田晃治, 須藤憲一: 胸部大動脈瘤手術における抗血栓コーティング処理部分体外循環法の有用性. 人工臓器 24: 507, 1995 22) Sierra-Quiroga J, Rubio-Alvarez J, Duran Munoz D, Garcia-Bengochea JB: Aortic valve replacement with heparin-coated perfusion system [letter; comment]. Ann Thorac Surg 58: 603, 1994 4) Nilsson L, Peterson C, Venge P, Borowiec JW, Thelin S: Eosinophil granule proteins in cardiopulmonary bypass with and without heparin coating [see comments]. Ann Thorac Surg 59: 713, 1995 16) 山中淳, 竹中靖夫, 五味昭彦, 鳥井晋造: ヘパリンコーティング体外循環回路を用いた開心術における凝固・線溶・補体系活性の検討. 人工臓器 24: 537, 1995 17) 坂田洋一: A-4線溶系反応とその制御機構. 臨床血栓止血学, 櫻川信男, 池田康夫編 医歯薬出版 東京 35, 1994 12) 野一色泰晴: 血液と人工臓器材料との界面現象. 人工臓器 10: 758, 1981 2) Fosse E, Moen O, Johnson E, Semb G, Brockmeier V, Molines TE, Fagerhol MK, Venge P: Reduced complement and granulocyte activation with heparin-coated cardiopulmonary bypass. Ann Thorac Surg 58: 472, 1994 8) Young JA, Kisker CT, Doty DB: Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann Thorac Surg 26: 231, 1978 10) 重光修, 葉玉哲生, 森義顕, 迫秀則, 添田徹, 川脇雄次, 内田雄三: ヘパリン結合された人工肺 (carmeda MAXIMA) と回路の生体適合性の臨床的検討. 人工臓器 23: 606, 1994 18) 碓氷章彦, 廣浦学, 大島英揮, 村上文彦, 川村光生: 体外循環におけるバイオサーフェイス回路の有用性に関する研究. 人工臓器 24: 548, 1995 5) 堀本仁士, 佐々木進次郎, 麻田邦夫, 小玉敏宏, 西本泰久: ヘパリン結合型人工心肺回路の有用性に関する検討. 人工臓器 24: 544, 1995 14) Borowiec J, Thelin S, Bagge L, Nilsson L, Venge P, Hansson HE: Heparin-coated circuits reduce activation of granulocytes during cardiopulmonary bypass. A clinical study. J Thorac Cardiovasc Surg 104: 642, 1992 3) Pekna M, Hagman L, Halden E, Nilsson UR, Nilsson B, Thelin S: Complement activation during cardiopulmonary bypass: effects of immobilized heparin [see comments]. Ann Thorac Surg 58: 421, 1994 15) Hattersly PG: Activated coagulation time of whole blood. JAMA 196: 436, 1966 1) Ovrum E, Molines TE, Fosse E, Holen EA, Tangen G, Abdelnoor M, Ringdal MA, Oystese R, Venge P: Complement and granulocyte activation in two different types of heparinized extracorporeal circuits. J Thorac Cardiovasc Surg 110: 1623, 1995 20) 増田宏, 豊平均, 森山由紀則, 西元寺秀明, 下川新二, 平明: ヘパリンコーティング人工心肺システムの有用性に関する検討. 人工臓器 23: 309, 1994 19) 宮本裕治, 中埜粛, 高野弘志, 松田暉: 開心術における血液凝固とその制御―nafamostat mesilate (FUT) の作用とヘパリンコーティングの生体適合性に及ぼす効果について―. 人工臓器 23: 606, 1994 21) Jones DR, Hill RC, Vasilakis A, Hollingsed MJ, Graeber GM, Gustafson RA, Cruzzavala JL, Murray GF: Safe use of heparin-coated bypass circuits incorporating a pump-oxygenator. Ann Thorac Surg 57: 815, 1994 11) Muehrcke DD, McCarthy PM, Kottke-Marchant K, Harasaki H, Pierre-Pared J, Borsh JA, Ogella DA, Cosgrove DM: Biocompatibility of heparin-coated extracorporeal bypass circuits: A randomized, masked clinical trial. J Thorac Cardiovasc Surg 112: 472, 1992 |
| References_xml | – reference: 2) Fosse E, Moen O, Johnson E, Semb G, Brockmeier V, Molines TE, Fagerhol MK, Venge P: Reduced complement and granulocyte activation with heparin-coated cardiopulmonary bypass. Ann Thorac Surg 58: 472, 1994 – reference: 4) Nilsson L, Peterson C, Venge P, Borowiec JW, Thelin S: Eosinophil granule proteins in cardiopulmonary bypass with and without heparin coating [see comments]. Ann Thorac Surg 59: 713, 1995 – reference: 3) Pekna M, Hagman L, Halden E, Nilsson UR, Nilsson B, Thelin S: Complement activation during cardiopulmonary bypass: effects of immobilized heparin [see comments]. Ann Thorac Surg 58: 421, 1994 – reference: 20) 増田宏, 豊平均, 森山由紀則, 西元寺秀明, 下川新二, 平明: ヘパリンコーティング人工心肺システムの有用性に関する検討. 人工臓器 23: 309, 1994 – reference: 17) 坂田洋一: A-4線溶系反応とその制御機構. 臨床血栓止血学, 櫻川信男, 池田康夫編 医歯薬出版 東京 35, 1994 – reference: 13) Gott VL, Whiffen JD, Dutton RC: Heparin bonding on colloidal graphite surfaces. Science 142: 1297, 1963 – reference: 21) Jones DR, Hill RC, Vasilakis A, Hollingsed MJ, Graeber GM, Gustafson RA, Cruzzavala JL, Murray GF: Safe use of heparin-coated bypass circuits incorporating a pump-oxygenator. Ann Thorac Surg 57: 815, 1994 – reference: 15) Hattersly PG: Activated coagulation time of whole blood. JAMA 196: 436, 1966 – reference: 1) Ovrum E, Molines TE, Fosse E, Holen EA, Tangen G, Abdelnoor M, Ringdal MA, Oystese R, Venge P: Complement and granulocyte activation in two different types of heparinized extracorporeal circuits. J Thorac Cardiovasc Surg 110: 1623, 1995 – reference: 12) 野一色泰晴: 血液と人工臓器材料との界面現象. 人工臓器 10: 758, 1981 – reference: 10) 重光修, 葉玉哲生, 森義顕, 迫秀則, 添田徹, 川脇雄次, 内田雄三: ヘパリン結合された人工肺 (carmeda MAXIMA) と回路の生体適合性の臨床的検討. 人工臓器 23: 606, 1994 – reference: 14) Borowiec J, Thelin S, Bagge L, Nilsson L, Venge P, Hansson HE: Heparin-coated circuits reduce activation of granulocytes during cardiopulmonary bypass. A clinical study. J Thorac Cardiovasc Surg 104: 642, 1992 – reference: 8) Young JA, Kisker CT, Doty DB: Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann Thorac Surg 26: 231, 1978 – reference: 16) 山中淳, 竹中靖夫, 五味昭彦, 鳥井晋造: ヘパリンコーティング体外循環回路を用いた開心術における凝固・線溶・補体系活性の検討. 人工臓器 24: 537, 1995 – reference: 19) 宮本裕治, 中埜粛, 高野弘志, 松田暉: 開心術における血液凝固とその制御―nafamostat mesilate (FUT) の作用とヘパリンコーティングの生体適合性に及ぼす効果について―. 人工臓器 23: 606, 1994 – reference: 22) Sierra-Quiroga J, Rubio-Alvarez J, Duran Munoz D, Garcia-Bengochea JB: Aortic valve replacement with heparin-coated perfusion system [letter; comment]. Ann Thorac Surg 58: 603, 1994 – reference: 5) 堀本仁士, 佐々木進次郎, 麻田邦夫, 小玉敏宏, 西本泰久: ヘパリン結合型人工心肺回路の有用性に関する検討. 人工臓器 24: 544, 1995 – reference: 7) Gorman RC, Ziats N, Rao AK, Gikakis N, Sun L, Khan MM, Stenach N, Sapatnekar S, Chouhan V, Gorman J, Niewiarowski S, Colman RW, Anderson JM, Edmunds L Jr: Surface-bound heparin fails to reduce thrombin formation during clinical cardiopulmonary bypass. J Thorac Cardiovasc Surg 111: 1, 1996 – reference: 9) 井手博文, 藤木達雄, 小石沢正, 渡邊寛, 江上純, 林信成, 相崎雅弘, 小久保純, 野中健史, 戸成邦彦, 笹川成, 本田克彦, 有村康夫, 池田晃治, 須藤憲一: 胸部大動脈瘤手術における抗血栓コーティング処理部分体外循環法の有用性. 人工臓器 24: 507, 1995 – reference: 11) Muehrcke DD, McCarthy PM, Kottke-Marchant K, Harasaki H, Pierre-Pared J, Borsh JA, Ogella DA, Cosgrove DM: Biocompatibility of heparin-coated extracorporeal bypass circuits: A randomized, masked clinical trial. J Thorac Cardiovasc Surg 112: 472, 1992 – reference: 18) 碓氷章彦, 廣浦学, 大島英揮, 村上文彦, 川村光生: 体外循環におけるバイオサーフェイス回路の有用性に関する研究. 人工臓器 24: 548, 1995 – reference: 6) 宮本裕治: 人工心肺下体外循環中の血中補体活性化に関する臨床的検討. 日胸外会誌 34: 2055, 1986 |
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| Title | Clinical evaluation of totally heparin-coated cardiopulmonary bypass circuits on coagulation, fibrinolysis, platelets, and complement system |
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