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Öğe Clinical and biomaterial evaluation of hyaluronan-based heparin-bonded extracorporeal circuits with reduced versus full systemic anticoagulation in reoperation for coronary revascularization(Lippincott Williams & Wilkins, 2009) Günaydın, Serdar; Farsak, Bora; Mccusker, Kevin; Vijay, Venkataramana; Sarı, Tamer; Onur, M. Ali; Zorlutuna, YamanObjective This prospective randomized study compares full and reduced heparinization on novel hyaluronan-based heparin-bonded circuits vs. uncoated controls under challenging clinical setting including biomaterial evaluation. Methods 100 patients undergoing reoperation for coronary artery bypass grafting were allocated into two equal groups (n = 50): Group one was treated with hyaluronan-based heparin bonded preconnected circuits (Vision HFOGBS, Gish, California, USA) and Group two with identical uncoated controls (Vision HFO, Gish, USA). In the study group, half of the patients (n = 25) received low-systemic heparin (125 IU/kg, ACT>250 s) or full dose like control group. Blood samples were collected after induction of anesthesia (T1) and heparin administration before cardiopulmonary bypass (CPB) (T2),15 min after initiation of CPB (T3), before cessation of CPB (T4),15 min after reversal with protamine (T5), and the first postoperative day at 08: 00 h (T6). Results Platelet counts were preserved significantly better at T5, T6 in hyaluronan groups (P<0.05 vs. control). Serum IL-2 levels were significantly lower at T4, T5 in both hyaluronan groups and C3a levels at T4 and T5 only in low-dose group (P<0.05). Troponin-T levels in coronary sinus blood demonstrated well preserved myocardium in hyaluronan groups. No significant differences in thrombin-antithrombin levels were observed between full and low-dose heparin groups at any time point. Amount of desorbed protein was 1.41 +/- 0.01 in full and 1.43 +/- 0.01 in low dose vs. 1.78 +/- 0.01 mg/dl in control (P<0.05). Conclusion Hyaluronan-based heparin-bonded circuits provided better clinical outcome and less inflammatory response compared with uncoated surfaces. Reduced systemic heparinization combined with hyaluronan-based heparin-bonded circuits is feasible and clinically well tolerated. J Cardiovasc Mad 10:135-142 (C) 2009 Italian Federation of Cardiology.Öğe Clinical efficacy of leukofiltration on cardiopulmonary bypass related inflammatory response: Fact or Foe?(Springer Basel Ag, 2009) Kılıç, Dilek; Günaydın, Serdar; Kısa, Üçler; Sari, Tamer; Deveci, Özcan; Zorlutuna, YamanThe powerful precept of preoperative risk assessment has been applied to compare the efficacy of leukofiltration techniques for high-risk cohorts with the documentation of broad indicators of systemic inflammation. Forty high risk patients were prospectively assigned to four perfusion protocols; the first group (n=10): Polyethyleneoxide (PEO) based heparin bonded extracorporeal circuits (ECC) + Continuous Leukocyte filtration; the second group (n=10): uncoated ECC + leukofiltration; the third group (n=10): PEO based heparin bonded ECC without leukofiltration; and control (n=10). Blood samples were obtained at the following intervals: Baseline (T1), on cardiopulmonary bypass (CPB) (T2), Cross clamp (T3), off CPB (T4), Intensive care unit-24 h (ICU24) (T5), ICU48 (T6). Tumor Necrosis Factor-alpha levels were significantly lower in Group 1 at T3, T4 (p < 0.05) vs. control. Procalcitonin levels were significantly lower in Group 1 at T5, T6 (p < 0.05) vs. control. Creatinine kinase-MB levels in coronary sinus blood demonstrated well preserved myocardium in filtered+coated (Group1) and coated groups (Group3) (p < 0.05). Matrix metallopeptidase- 9 and D-Dimer levels in filtered+coated group were significantly lower at T5 and T6 vs. control (p < 0.05). Leukocyte filtration on coated surfaces alleviated systemic inflammatory response with a better clinical outcome in high risk patients.Öğe Clinical evaluation of leukocyte filtration as an alternative anti-inflammatory strategy to aprotinin in high-risk patients undergoing coronary revascularization(Springer, 2012) Farsak, Bora; Gunaydin, Serdar; Yildiz, Ulku; Sari, Tamer; Zorlutuna, YamanPurpose The use of aprotinin in cardiac surgery is associated with overriding safety concerns. Therefore, there is increased research on alternatives. This study investigated the relative benefits of strategic leukofiltration on polymer-coated extracorporeal circuits (ECC), aprotinin, and combined therapy in high-risk patients. Methods Eight hundred and seventy-five patients (Euro-SCORE 6+) undergoing coronary revascularization over a 4-year period were prospectively randomized to one of four perfusion protocols: Group 1: polymethoxyethylacrylate (PMEA)-coated circuits + leukocyte filters (n = 214); Group 2: uncoated ECC + full Hammersmith aprotinin (n = 212); Group 3: PMEA-coated ECC + leukofilters + full Hammersmith aprotinin (n = 199); and Group 4: control no treatment (n = 250). Blood samples were collected at times T1: following the induction of anesthesia; T2: following heparin administration; T3: 15 min after cardiopulmonary bypass (CPB); T4: before cessation of CPB; T5: 15 min after protamine reversal; and T6: in the intensive care unit. Results The serum interleukin-2 levels were significantly lower at T3, T4, and T5 in all study groups. C3a levels were significantly lower at T3. Creatine kinase MB and lactate levels demonstrated well-preserved myocardia in both leukofiltration groups (P < 0.05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups. Postoperative bleeding and respiratory support time were lower in all study groups. Conclusion Leukofiltration on coated circuits significantly reduced bleeding and inflammatory response related to CPB with no adverse effects, and may be a possible alternative to pharmacological intervention.Öğe Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function(Sage Publications Ltd, 2009) Günaydın, Serdar; Sarı Tamer; McCusker, Kevin; Schonrock, Uwe; Zorlutuna, YamanObjective: We examined intraoperative microembolic signals (GME), inflammatory response, hemolysis, perioperative regional cerebral oxygen saturation (rSO(2)), myocardial protection and desorbed protein amount on oxygenator fibers in high-risk patients undergoing coronary revascularization (CABG) with minimized and conventional cardiopulmonary bypass (CPB). Methods: Over a ten-month period, 40 Euroscore 6+ patients undergoing CABG were prospectively randomized to one of the two perfusion protocols (N=20): Group 1: minimized extracorporeal circuits (Mini-CPB) (ROCsafe MPC, Terumo, Ann Arbor, MI, USA) and Group 2: conventional extracorporeal circuits (CECC) (Capiox SX18, Terumo, USA). Serum creatinine kinase-MB (CKMB), free hemoglobin, interleukin-6 (IL-6) and C3a levels were measured. Blood samples were collected at T1: following induction of anesthesia; T2: thromboelastography control; T3: 15 min after commencement of CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal and T6: ICU. Results: Serum IL-6 levels were significantly lower in the Mini-CPB group at T4 and T5 and C3a levels were significantly less in the Mini-CPB group at T3, T4 and T5 vs. CECC (p < 0.01). CKMB levels in coronary sinus blood demonstrated well preserved myocardium in the Mini-CPB group. Percentage expression of neutrophil CD11b/CD18 levels were significantly lower in the Mini-CPB group at T4 and T5 (p < 0.05). There were no significant differences in air handling characteristics or free plasma hemoglobin levels in either circuit. rSO(2) measurements were significantly better at T3 and T4 in the Mini-CPB vs. CECC (p < 0.05) and always higher in the Mini-CPB during follow-up. Blood protein adsorption analysis of oxygenator membranes demonstrated a significantly increased amount of microalbumin on CECC fibers (p < 0.05). Conclusion: Mini-CPB provided a comfort and safety level similar to conventional control via satisfactory air handling, attenuated inflammatory response and hemodilution, with a better clinical outcome in patients undergoing high-risk CABG.Öğe Clinical performance and biocompatibility of hyaluronan-based heparin-bonded extracorporeal circuits in different risk cohorts(Oxford Univ Press, 2010) Gunaydin, Serdar; McCusker, Kevin; Sari, Tamer; Onur, Mehmet Ali; Zorlutuna, YamanThis prospective randomized study compares novel hyaluronan-based heparin-bonded circuits vs. uncoated controls across EuroSCORE patient risk strata including biomaterial evaluation. Over a two-year period, 90 patients undergoing coronary artery bypass grafting were prospectively randomized to one of the two perfusion protocols: Group 1 was treated with hyaluronan-based heparin-bonded preconnected circuits (Vision HFO-GBS (TM), Gish, CA, USA) and Group 2 with identical uncoated controls. Each group was composed of three subgroups (n = 15) with respect to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high (6+) risk patients. Blood samples were collected after induction (T1) and heparinization (T2), 15 min after cardiopulmonary bypass start (T3), before cessation of CPB (T4), 15 min after reversal (T5), and the first postoperative day (T6). In high-risk patients, platelet counts demonstrated significant preservation at T4, T5 and leukocyte counts were lower at T5 in hyaluronan group (P <= 0.05 vs. control). C3a (ng.ml(-1)) levels were significantly lower at T3 (0.2 +/- 0.04 vs. 0.31 +/- 0.05), T4 (0.25 +/- 0.04 vs. 0.51 +/- 0.05), T5 (0.38 +/- 0.04 vs. 0.56 +/- 0.05) and interleukin-6 (pg.ml(-1)) at T4 (91 +/- 18 vs. 124 +/- 20), T5 (110 +/- 20 vs. 220 +/- 25) in coated group vs. control (P <= 0.05). Protein desorption (microalbumin) on fibers (mg.mm(-3)) was less in hyaluronan vs. control groups (P <= 0.05). Hyaluronan coating reduced platelet adhesion and cell adsorption, and modulated inflammatory response in high-risk patients. (c) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.Öğe Comparison of polymethoxyethylacrylate-coated circuits with leukocyte filtration and reduced heparinization protocol on heparin-bonded circuits in different risk cohorts(Sage Publications Ltd, 2006) Günaydin, Serdar; McCusker, Kevin; Vijay, Venkataramana; İşbir, Selim; Sari, Tamer; Onur, Mehmet Ali; Zorlutuna, YamanObjectives: The relative benefits of strategic leukofiltration on polymer-coated and low-dose heparin protocol on heparin-coated circuits were studied across EuroSCORE patient risk strata for three different cohorts. Methods: In a prospective, randomized study, 270 patients undergoing coronary artery bypass grafting were allocated into three groups (n = 90): Group 1 - polymethoxyethylacrylate-coated circuits + leukocyte filters; Group 2 - polypeptide-based heparin-bonded circuits with reduced heparinization; and Group 3 - Control: uncoated circuits. Each group was further divided into three subgroups (n = 30), with respect to low- (EuroSCORE 0-2), medium- (3-5), and high- (6+) risk patients. Blood samples were collected at T1: following induction of anesthesia; T2: following heparin administration; T3: 15 min after CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal; and T6: ICU. Results: In high-risk cohorts, leukocyte counts demonstrated significant differences at T4 and T5 in Group 1, and at T4 in Group 2. Platelet counts were preserved significantly better at T4 and T5 in both groups (p < 0.05 versus control). Serum IL-2 and C3a levels were significantly lower at T3, T4 and T5 in Group 1, and T4 and T5 in Group 2 (p < 0.05). Postoperative bleeding, respiratory support time and incidence of atrial fibrillation were lower in the study groups versus control. Cell counts on filter mesh and heparin-coated fibers/ circuits were significantly higher in the high-risk cohorts versus uncoated fibers. Phagocytic capacity increased on filter mesh, especially in high-risk specimens. SEM evaluation demonstrated better preserved coated circuits. Conclusion: Leukofiltration and coating reduced platelet adhesion, protein adsorption, atrial fibrillation and reduced heparinization acted via modulation of systemic inflammatory response in high-risk groups.
