Gunaydin Serdar, McCusker Kevin, Sari Tamer, Onur Mehmet Ali, Zorlutuna Yaman
University of Kirikkale, Angora Evleri G-8 Bl. No: 1, Ankara, Turkey.
Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):371-6. doi: 10.1510/icvts.2009.220756. Epub 2009 Dec 21.
This 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, 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<or=0.05 vs. control). C3a (ng x 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 x ml(-1)) at T4 (91+/-18 vs. 124+/-20), T5 (110+/-20 vs. 220+/-25) in coated group vs. control (P<or=0.05). Protein desorption (microalbumin) on fibers (mg x mm(-3)) was less in hyaluronan vs. control groups (P<or=0.05). Hyaluronan coating reduced platelet adhesion and cell adsorption, and modulated inflammatory response in high-risk patients.
这项前瞻性随机研究比较了新型基于透明质酸的肝素结合回路与未涂层对照在欧洲心脏手术风险评估系统（EuroSCORE）患者风险分层中的效果，包括生物材料评估。在两年时间里，90例接受冠状动脉旁路移植术的患者被前瞻性随机分为两种灌注方案之一：第1组接受基于透明质酸的肝素结合预连接回路（Vision HFO - GBS，Gish，加利福尼亚州，美国）治疗，第2组接受相同的未涂层对照。根据术前评估的低（EuroSCORE 0 - 2）、中（3 - 5）和高（6+）风险患者，每组又分为三个亚组（n = 15）。在诱导后（T1）和肝素化后（T2）、体外循环开始后15分钟（T3）、体外循环停止前（T4）、肝素逆转后15分钟（T5）以及术后第一天（T6）采集血样。在高危患者中，透明质酸组在T4时血小板计数显示出显著的保存，在T5时白细胞计数较低（与对照组相比，P≤0.05）。涂层组在T3（0.2±0.04对0.31±0.05）、T4（0.25±0.04对0.51±0.05）、T5（0.38±0.04对0.56±0.05）时C3a（ng·ml⁻¹）水平显著较低，在T4（91±18对124±20）、T5（110±20对220±25）时白细胞介素-6（pg·ml⁻¹）水平显著低于对照组（P≤0.05）。与对照组相比，透明质酸组纤维上的蛋白质解吸（微量白蛋白）（mg·mm⁻³）较少（P≤0.05）。透明质酸涂层减少了高危患者的血小板黏附和细胞吸附，并调节了炎症反应。
