Original articleCardiovascularEffects of Methylprednisolone and a Biocompatible Copolymer Circuit on Blood Activation During Cardiopulmonary Bypass
Section snippets
Material and Methods
This clinical trial was approved by the Human Research Ethics Board of the Ottawa Heart Institute. Informed consent was obtained before participation from eligible patients who were scheduled for coronary artery bypass grafting (CABG) on CPB. Exclusion criteria consisted of those patients on steroids or Coumadin and those undergoing emergency, reoperative surgery or other cardiac procedures in addition to CABG. Patients were also excluded if there was evidence of preoperative coagulopathy,
Results
The demographics and the operative characteristics of the patients in each of the four groups are listed in Table 1. Three patients were excluded after randomization but before intervention due to surgeon request and no sampling was done. All other patients (n = 17 per group) completed the study with full follow-up.
Comment
In the face of an increasing number of high risk patients undergoing cardiac surgery, a new paradigm for cardiopulmonary bypass management must be developed with strategies to limit systemic activation by incorporating the best available biocompatible circuits with complementary pharmacologic agents. We [1] and others [6] have demonstrated the thromboresistant properties of SMA-CPB, however its ability to limit inflammation related to systemic activation was less evident. Therefore, we elected
References (35)
- et al.
Plasma bradykinin in angio-oedema
Lancet
(1998) - et al.
CDC definitions for nosocomial infections
Am J Infect Control
(1988) - et al.
Cardiopulmonary bypass circuit treated with surface modifying additives (SMA): a clinical evaluation of blood compatibility
Ann Thorac Surg
(1998) - et al.
Vasodilation and cardiopulmonary bypass: the role of bradykinin and the pulmonary vascular endothelium
Chest
(2001) - et al.
Formation of C1s-C1-inhibitor, kallikrein-C1-inhibitor, and plasmin-alpha 2-plasmin-inhibitor complexes during cardiopulmonary bypass
Blood
(1989) - et al.
Effects of nafamostat mesilate and minimal-dose aprotinin on blood-foreign surface interactions in cardiopulmonary bypass
Ann Thorac Surg
(2004) - et al.
Influence of PMEA-coated bypass circuits on perioperative inflammatory response
Ann Thorac Surg
(2003) - et al.
Limitation of thrombin generation, platelet activation, and inflammation by elimination of cardiotomy suction in patients undergoing coronary artery bypass grafting treated with heparin-bonded circuits
J Thorac Cardiovasc Surg
(2002) - et al.
Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass
J Thorac Cardiovasc Surg
(1991) - et al.
Cytokine release and neutrophil activation are not prevented by heparin-coated circuits and aprotinin administration
Ann Thorac Surg
(2000)
Effect of methylprednisolone on endotoxemia and complement activation during cardiac surgery
J Cardiothorac Anesth
Reduced complement and granulocyte activation with heparin-coated cardiopulmonary bypass
Ann Thorac Surg
Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?
J Cardiothorac Vasc Anesth
Anaphylactoid reactions during hemodialysis on AN69 membranes in patients receiving ACE inhibitors
Kidney Int
Corticosteroids and cardiopulmonary bypass: a review of clinical investigations
Chest
Hematologic evaluation of cardiopulmonary bypass circuits prepared with a novel block copolymer
Ann Thorac Surg
Circuits with surface modifying additive alter the haemondynamic response to cardiopulmonary bypass
Eur J Cardiothorac Surg
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