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

Harig, Frank; Meier, Christoph A.; Hakami, L.; Strasser, Rosemary; Bretzger, J; Münch, Frank; Vestweber-Wilmes, E.; H, Singer; Weyand, M; Cesnjevar, Robert

doi:10.1055/s-2005-872863

Cited by 5 publications

(3 citation statements)

References 10 publications

(17 reference statements)

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“…In contrast, our CD47 has been shown to effectively reduce the inflammatory response in in vitro , in vivo , and ex vivo conditions. In addition, despite decades of research and clinical trials, the benefits of heparin coated surfaces for clinical applications remains undecided [24,30–32]. We contend that CD47 modified surfaces, with their demonstrated ability to inhibit both inflammatory cells response and platelet activation, may confer a high level of biocompatibility for clinical applications.…”

Section: Discussionmentioning

confidence: 99%

Diminished adhesion and activation of platelets and neutrophils with CD47 functionalized blood contacting surfaces

et al. 2012

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CD47 is a ubiquitously expressed transmembrane protein that, through signaling mechanisms mediated by signal regulatory protein alpha (SIRPα1), functions as a biological marker of ‘self-recognition’. We showed previously that inflammatory cell attachment to polymeric surfaces is inhibited by the attachment of biotinylated recombinant CD47 (CD47B). We test herein the hypothesis that CD47-modified blood conduits can reduce platelet and neutrophil activation under clinically relevant conditions. We appended a poly-lysine tag to the C-terminus of recombinant CD47 (CD47L) allowing for covalent linkage to the polymer. SIRPα1 expression was confirmed in isolated platelets. We then compared biocompatibility between CD47B and CD47L functionalized polyvinyl chloride (PVC) surfaces and unmodified control PVC surfaces. Quantitative and Qualitative analysis of blood cell attachment to CD47B and CD47L surfaces, via scanning electron microscopy, showed strikingly fewer platelets attached to CD47 modified surfaces compared to control. Flow cytometry analysis showed that activation markers for neutrophils (CD62L) and platelets (CD62P) exposed to CD47 modified PVC were equivalent to freshly acquired control blood, while significantly elevated in the unmodified PVC tubing. In addition, ethylene oxide gas sterilization did not inhibit the efficacy of the CD47 modification. In conclusion, CD47 modified PVC inhibits both the adhesion and activation of platelets and neutrophils.

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Section: Discussionmentioning

confidence: 99%

Diminished adhesion and activation of platelets and neutrophils with CD47 functionalized blood contacting surfaces

et al. 2012

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“…The causes of fluid overload may be the physiological characteristics of children (the physiological hydrophilic of fabric, the imperfection of kidneys functions, as well as their post-operative injury), conducting cardiopulmonary bypass (CB) (the mismatch of the circulating blood volume (CBV) of a child and the primary volume filling the circuit of the CB device, the introduction of exogenous fluids, the incompatibility of the CB circuit materials and the patient's blood, which in turn can trigger an enzyme cascade, which leads to the development of the capillary leak syndrome) [3,15].This pathological condition can be fixed by two methods of ultrafiltration: ultrafiltration (UF) during CB and modified ultrafiltration (MUF) [6,8,9]. …”

mentioning

confidence: 99%

“…This pathological condition can be fixed by two methods of ultrafiltration: ultrafiltration (UF) during CB and modified ultrafiltration (MUF) [6,8,9]. …”

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confidence: 99%

Methods of modified ultrafiltration in the surgical correction of transposition of the great arteries in newborns

Bolatovich¹,

Kamalovich²,

Duisenovna³

2017

Medical news of the North Caucasus

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Surgery 270I n the world the number of operations carried out for congenital heart disease (CHD) is increasing each year, including those executed in the neonatal period [1].One of the main intraoperative problems faced by an anesthesiologist and a perfusionist is the violation of child's hydrobalance and its correction. The causes of fluid overload may be the physiological characteristics of children (the physiological hydrophilic of fabric, the imperfection of kidneys functions, as well as their post-operative injury), conducting cardiopulmonary bypass (CB) (the mismatch of the circulating blood volume (CBV) of a child and the primary volume filling the circuit of the CB device, the introduction of exogenous fluids, the incompatibility of the CB circuit materials and the patient's blood, which in turn can trigger an enzyme cascade, which leads to the development of the capillary leak syndrome) [3,15].This pathological condition can be fixed by two methods of ultrafiltration: ultrafiltration (UF) during CB and modified ultrafiltration (MUF) [6,8,9].According to the literature, the positive ultrafiltration effects are: the reduction of myocardial edema, increased blood pressure, decreased heart rate, decreased central venous pressure, reduced need for inotropes [7, 11], improved oxygenation and reduction of extravascular lung water [4,13], decrease in the severity of postperfusion systemic inflammatory response (reduction of plasma levels of proinflammatory cytokines), increased creatinine clearance and decreased total water content in the body [2,10], increased hematocrit (Ht) and coagulation factors in the plasma, thereby -reducing the use of transfusion media [5,12,14].There is an ongoing and intensive study of the use of ultrafiltration in the practice of child cardioanesthesiology. Our interest is to evaluate the effectiveness of ultrafiltration in combination of anesthetic management during the correction of transposition of the great arteries (TGA) in newborns. The purpose of the research is to evaluate the effectiveness of two methods of ultrafiltration in the correction of transposition of the great arteries in newborns. Correction of congenital heart defects in newborns in the cardiopulmonary bypass is accompanied by volumetric fluid overload. To eliminate this pathological condition an ultrafiltration method is used. The article presents the correction analysis of the years 2012-2016 to 20 newborns with transposition of the great arteries with the use of two methods of ultrafiltration during cardiopulmonary bypass: I group (n=10) -ultrafiltration, II group (n=10) -modified ultrafiltration after cardiopulmonary bypass stop. The findings suggest that in the group which underwent a modified ultrafiltration, the inotropic support index, the need for blood transfusion in the immediate postoperative period, the patient's time spent on mechanical ventilation was significantly lower than in the group of children which underwent ultrafiltration. Keywords: transposition of great arteries, ultrafiltration, modif...

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ECMO Therapy and the Heart-Lung Machine

Klauwer

2018

A Practical Handbook on Pediatric Cardiac Intensive Care Therapy

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

Cited by 5 publications

References 10 publications

Diminished adhesion and activation of platelets and neutrophils with CD47 functionalized blood contacting surfaces

Diminished adhesion and activation of platelets and neutrophils with CD47 functionalized blood contacting surfaces

Methods of modified ultrafiltration in the surgical correction of transposition of the great arteries in newborns

ECMO Therapy and the Heart-Lung Machine

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