Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.
Paracelsus Medical University, Nuremberg, Germany.
Perfusion. 2021 Nov;36(8):781-785. doi: 10.1177/0267659120968364. Epub 2020 Oct 28.
The inflammatory response in cardiac surgery using extracorporeal circulation (ECC) has been widely discussed in the literature with analysis on cytokines released in humans; demonstrating manifold trigger causes. To mitigate this response-mainly linked to the contact and recognition by the blood of a "non-self" surface-many efforts have been made to make the circuits of the extra-corporeal circulation "biomimetics"; trying to emulate the cardio-vascular system. In other words, biomedical companies have developed many biocompatible products in order to reduce the invasiveness of the ECC. One of the techniques used to reduce the contact of blood with "nonself" surfaces is the "coating" of the internal surfaces of the ECC. This can be done with phospholipidic, electrically neutral, and heparin derivates with anticoagulant activity. The coating can be divided into two categories: the "passive coating" with Phosphorylcholine by biomedical companies and the administration of albumin added to the "priming" during the filling of the circuit by the perfusionist. Alternatively, we have the "active" coating: treatment of the internal surfaces in contact with the blood with neutral proteins and heparin. The latter are different according to the production company, but the aim is always to maintain high levels of systemic and local anticoagulation, inactivating the "contact" coagulation between the blood and the surfaces. A recent study demonstrates that the use of an "active coating" is associated with better preservation of the endothelial glycocalyx compared with "passive coating" circuits.
体外循环（ECC）下心内直视手术中的炎症反应在文献中已有广泛讨论，对人体释放的细胞因子进行了分析，证明有多种触发原因。为了减轻这种反应——主要与血液与“非自身”表面的接触和识别有关——人们做了很多努力使体外循环的回路具有“仿生学”特性；试图模拟心血管系统。换句话说，生物医学公司已经开发了许多生物相容性产品，以降低 ECC 的侵袭性。减少血液与“非自身”表面接触的技术之一是 ECC 内部表面的“涂层”。这可以通过磷脂、电中性和具有抗凝活性的肝素衍生物来完成。涂层可分为两类：生物医学公司的 Phosphorylcholine“被动涂层”和灌注师在填充回路时添加白蛋白的“预充”。或者，我们有“主动”涂层：用中性蛋白和肝素处理与血液接触的内部表面。后者因生产厂家而异，但目的始终是保持全身和局部抗凝水平高，使血液和表面之间的“接触”凝血失活。最近的一项研究表明，与“被动涂层”回路相比，使用“主动涂层”可更好地保留内皮糖萼。
