A Closed Perfusion System With Heparin Coating and Centrifugal Pump Improves Cardiopulmonary Bypass Biocompatibility in Elderly Patients

Background Cardiopulmonary bypass induces a systemic inflammatory and hemostatic activation, which may contribute to postoperative complications. Our aim was to compare the inflammatory response, coagulation, and fibrinolytic activation between two different perfusion systems: one theoretically more biocompatible with a closed-circuit, complete heparin coating, and a centrifugal pump, and one conventional system with uncoated circuit, roller pump, and a hard-shell venous reservoir. Methods Forty-one elderly patients (mean age, 73 ± 1 years, 66% men) undergoing coronary artery bypass grafting or aortic valve replacement were included in a prospective, randomized study. Plasma concentrations of complement factors (C3a, C4d, Bb, and sC5b-9), proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-8), granulocyte degradation products (polymorphonuclear elastase), and markers of coagulation (thrombin-antithrombin) and fibrinolysis (D-dimer, tissue plasminogen activator antigen and tissue plasminogen activator–plasminogen activator inhibitor-1 complex) were measured preoperatively, at bypass during rewarming (35°C), 60 minutes after bypass, and on day 1 after surgery. Results The mean concentrations of C3a (−39%; p = 0.008), Bb (−38%; p< 0.001), sC5b-9 (−70%; p< 0.001), interleukin-8 (−60%; p = 0.009), polymorphonuclear-elastase (−55%; p< 0.003), and tissue plasminogen activator antigen (−51%; p = 0.012) were all significantly lower in the biocompatible group during rewarming. Sixty minutes after bypass, the mean concentrations of sC5b-9 (−39%; p = 0.006) and polymorphonuclear-elastase (−55%; p< 0.001) were lower in the biocompatible group. Conclusions The results suggest that a closed perfusion system with a heparin-coated circuit and a centrifugal pump may improve cardiopulmonary bypass biocompatibility in elderly cardiac surgery patients in comparison with a conventional system.