Multifactorial Comparison of Modified and Conventional Perfusion Strategies in A Porcine Model of Cardiopulmonary Bypass

Hussaini, Bader E.; Treanor, Patrick R.; Healey, Nancy A.; Lu, Xiangyi; Khuri, Shukri F.; Thatte, Hemant S.

doi:10.1016/j.jss.2010.01.037

Cited by 4 publications

(3 citation statements)

References 32 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further studies supporting the hematological benefits of using closed CPB systems were found by Casalino et al (16), Hussaini et al (17), and Lindholm and colleagues (18). Casalino et al compared the transfusion rates in 60 patients undergoing cardiopulmonary bypass randomly assigned to two different circuits: an open circuit and a closed circuit.…”

Section: Cardiopulmonary Bypass-closed Versus Openmentioning

confidence: 96%

Blood Management Issues: Getting Clots Together When You Want Them

McMillan,

Potger,

Southwell

2011

J Extra Corpor Technol

View full text Add to dashboard Cite

Coagulation is a complex process that allows whole blood to form clots at tissue and vessel sites where damage has occurred. Activation of the hemostasis system causes platelets and fibrin-containing clot to stop the bleeding. Perfusionists must find ways to preserve the coagulation system if we are to avoid bleeding in the cardiopulmonary bypass patient. It is still unclear what techniques are best to continue maintaining hemostasis and avoiding transfusion in patients requiring cardiopulmonary bypass (CPB). There are numerous factors that come into play with the use of CPB including deactivating the coagulation system with anticoagulants, hemodilution of the circulating blood volume, inflammatory response, and a possible pro-coagulant response from protamine with heparin reversal once the surgical procedure has been completed and CPB terminated. All these factors make achieving hemostasis post CPB extremely difficult. This review attempts to assess what is currently being discussed in the literature, which may improve hemostasis with cardiopulmonary bypass. There is still no one technique that will improve hemostasis post CPB. Perhaps the answer may lie in a combination of reported techniques that may in some way lead to the preserving of coagulation factors during CPB.

show abstract

Section: Cardiopulmonary Bypass-closed Versus Openmentioning

confidence: 96%

Blood Management Issues: Getting Clots Together When You Want Them

McMillan,

Potger,

Southwell

2011

J Extra Corpor Technol

View full text Add to dashboard Cite

show abstract

“…Hussaini and colleagues in an effort to develop a more biocompatible CPB circuit that reduces inflammation, thrombogenesis and end-organ injury tested a thromboresistant CPB circuit using a heparin-bonded circuit (HBC) (1). The use of HBC is controversial as prior human studies using HBC have reported modest reductions at best in complement activation (2) as well as postoperative length of stay and end-organ injury (3).…”

mentioning

confidence: 99%

“…The authors of this current study hypothesized that the outcomes using HBC may be improved by: 1) maintenance of a higher hematocrit (Hct) > 25%; 2) use of a closed perfusion system to eliminate the blood-gas interface (another site of foreign surface exposure); and 3) systemic normothermia. To study this, the authors compared HBC to conventional CPB (non-heparin-bonded circuits; NHB) in a porcine model (1). …”

mentioning

confidence: 99%

Thromboresistant Cardiopulmonary Bypass Circuits: Room for Improvement?

Poynter

2010

Journal of Surgical Research

View full text Add to dashboard Cite

KeywordsCardiopulmonary bypass; thromboresistant circuits; heparin-coated circuits Circulating blood contact with the surfaces of non-thromboresistant cardiopulmonary bypass (CPB) circuits induces several harmful inflammatory and hematological effects. Hussaini and colleagues in an effort to develop a more biocompatible CPB circuit that reduces inflammation, thrombogenesis and end-organ injury tested a thromboresistant CPB circuit using a heparinbonded circuit (HBC) (1). The use of HBC is controversial as prior human studies using HBC have reported modest reductions at best in complement activation (2) as well as postoperative length of stay and end-organ injury (3). However, these studies have been criticized for a possible selection basis. Nonetheless, the use of these circuits is associated with reduced circulating complement (4,5), interleukin-6 (5) and activated granulocytes (4,6). The authors of this current study hypothesized that the outcomes using HBC may be improved by: 1) maintenance of a higher hematocrit (Hct) > 25%; 2) use of a closed perfusion system to eliminate the blood-gas interface (another site of foreign surface exposure); and 3) systemic normothermia. To study this, the authors compared HBC to conventional CPB (non-heparinbonded circuits; NHB) in a porcine model (1). Anticoagulation as measured by ACT was achieved in both groups, although supratherapeutic levels were often achieved in the NHB group during CPB. Intraoperative hemodynamics were similar, and blood loss was higher in the NHB group as might be expected given the higher ACT (347.8 ± 79.3 ml vs. 214.1 ± 34.5 ml). In addition, thrombin anti-thrombin complex (TATIII) formation occurred more rapidly and remained elevated in the NHB group compared to the HBC group. Alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase and gamma-glutamyl transferase levels were also higher in the NHB group, and postoperative leukocyte and platelet counts were significantly lower. As might be expected, animals in the HBC group required 51% less heparin and 61% less protamine than in the NHB group. Microscopically, the arterial filters of the NHB circuits were clogged by activated leukocytes, red blood cells and platelets while the filters from HBC circuits were free of debris.

show abstract

Heparin coatings for improving blood compatibility of medical devices

Biran

Pond

2017

Advanced Drug Delivery Reviews

255

205

View full text Add to dashboard Cite

Blood contact with biomaterials triggers activation of multiple reactive mechanisms that can impair the performance of implantable medical devices and potentially cause serious adverse clinical events. This includes thrombosis and thromboembolic complications due to activation of platelets and the coagulation cascade, activation of the complement system, and inflammation. Numerous surface coatings have been developed to improve blood compatibility of biomaterials. For more than thirty years, the anticoagulant drug heparin has been employed as a covalently immobilized surface coating on a variety of medical devices. This review describes the fundamental principles of non-eluting heparin coatings, mechanisms of action, and clinical applications with focus on those technologies which have been commercialized. Because of its extensive publication history, there is emphasis on the CARMEDA BioActive Surface (CBAS Heparin Surface), a widely used commercialized technology for the covalent bonding of heparin.

show abstract

Multifactorial Comparison of Modified and Conventional Perfusion Strategies in A Porcine Model of Cardiopulmonary Bypass

Cited by 4 publications

References 32 publications

Blood Management Issues: Getting Clots Together When You Want Them

Blood Management Issues: Getting Clots Together When You Want Them

Thromboresistant Cardiopulmonary Bypass Circuits: Room for Improvement?

Heparin coatings for improving blood compatibility of medical devices

Contact Info

Product

Resources

About