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DOI: 10.1055/s-2005-862047
Does the additional use of heparin-coated extracorporeal circuits (ECC) optimize the effect of Modified Ultrafiltration (MUF) in pediatric perfusion?
Objectives: Modified ultrafiltration (MUF) has been shown to exert beneficial effects on the coagulation system and the capillary leak after pediatric cardiac surgery using extracorporeal circulation (ECC). Aim of this study was to investigate if the additional use of heparin-coated circuits is a useful option for improving biocompatibility.
Material and Methods: We randomized 28 children, using heparin-coated ECC- circuits in group A (n=14) and an uncoated equivalent set in group B (n=14). After congenital heart surgery, MUF was performed post ECC in a standardized fashion. Blood samples were analysed preoperatively, 10min, 30min, 1h and 48h after ECC by flow cytometric analysis (FACSort) using surface antigens CD62/CD41b (platelets) and CD45/CD14 (monocytes).
Results: No significant difference could be found concerning mean age (20.6 mon vs. 21.6 mon), mean body weight (9.2kg vs. 8.4kg), mean ultrafiltration rate (9.1ml/kg vs. 11.4ml/kg), chest tube drainage, blood products, ICU stay and 30d survival. The percentage of CD62/CD41-positive platelets in group A (vs. B) increased up to 118% at 60' vs. 130% [p<0.05] and declined to 98% at 48h postop. vs. 99% [n.s.]. The percentage of CD45/CD14-positive monocytes in group A (vs. B) increased up to 158% at 60' vs. 155% [n.s.] and declined to 122% (A) at 48h postop. vs. 61% (B) [p>0.05].
Conclusions: Heparin-coating of ECC plus MUF leads to lower platelet activation. Monocyte markers (CD45/CD14) indicated a marked activation during ECC in both groups, additional heparin coating showed a better regeneration of monocyte markers in the late postoperative course indicating a beneficial additive effect.