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• W1981966246 abstract "This systematic review and meta-analysis explores the clinical efficacy of biocompatible surfaces for cardiopulmonary bypass in adults. Thirty-six randomized controlled trials were retrieved for a total of 4360 patients. Patients treated with biocompatible circuits had a lower rate of packed red cells transfusions and atrial fibrillation, and shorter durations of stay in the intensive care unit. When the analysis was limited to high-quality studies, only a reduction in atrial fibrillation rate and a shorter stay in the intensive care unit remained significantly associated with the use of biocompatible surfaces. Using biocompatible surfaces without other measures to contain blood activation results in a limited clinical benefit. This systematic review and meta-analysis explores the clinical efficacy of biocompatible surfaces for cardiopulmonary bypass in adults. Thirty-six randomized controlled trials were retrieved for a total of 4360 patients. Patients treated with biocompatible circuits had a lower rate of packed red cells transfusions and atrial fibrillation, and shorter durations of stay in the intensive care unit. When the analysis was limited to high-quality studies, only a reduction in atrial fibrillation rate and a shorter stay in the intensive care unit remained significantly associated with the use of biocompatible surfaces. Using biocompatible surfaces without other measures to contain blood activation results in a limited clinical benefit. Biocompatible surfaces for cardiopulmonary bypass (CPB) circuits and oxygenators became commercially available in the late 1980s. The first biocompatible treatments were based on heparin bonding, either ionic or covalent. Subsequently, many different kinds of biocompatible treatments became available for clinical use, and currently all major companies manufacturing CPB equipment offer one or more options of biocompatible circuits. Even taking into account that some biologic differences exist among the different biocompatible treatments, the general philosophy is to mimic the endothelial surface by coating the CPB circuit and oxygenator with different types of molecules (heparin; poly2-methoxyethylacrylate; phosphorylcholine; siloxane/caprolactone; polyethylene oxide chains, sulfate/sulfonate groups). Many studies exploring biochemical markers of inflammation and activation of the hemostatic system have demonstrated a beneficial effect of these biocompatible treatments in terms of a decrease of the systemic inflammatory reaction to CPB, a lower degree of activation of the hemostatic system, a prevention of platelet adhesion and activation, and a preservation of platelet count. Despite these beneficial biochemical effects, many clinical studies have offered conflicting results with respect to the real efficacy of this approach in improving patient outcome. For example, the two largest randomized controlled trials (RCTs) published so far either failed to demonstrate any beneficial effect in low-risk patients undergoing coronary revascularization [1Wildevuur C.R. Jansen P.G. Bezemer P.D. et al.Clinical evaluation of Duraflo II heparin treated extracorporeal circulation circuits (2nd version) The European Working Group on heparin coated extracorporeal circulation circuits.Eur J Cardiothorac Surg. 1997; 11: 616-623Crossref PubMed Scopus (58) Google Scholar] or demonstrated only minor beneficial effects in terms of morbidity in specific subgroups of high-risk patients [2Ranucci M. Mazzucco A. Pessotto R. et al.Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial.Ann Thorac Surg. 1999; 67: 994-1000Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar]. Most published studies lack the power for detecting differences in morbidity and mortality: only six RCTs enrolled more than 100 patients in each arm. It is therefore reasonable to conduct a systematic review and meta-analysis focused on the main outcome measurements (morbidity and mortality) to analyze a reasonable number of patients. In 2007 Mangoush and coworkers [3Mangoush O. Purkayastha S. Haj-Yahia S. et al.Heparin-bonded circuits versus nonheparin-bonded circuits: an evaluation of their effect on clinical outcomes.Eur J Cardiothorac Surg. 2007; 31: 1058-1069Crossref PubMed Scopus (67) Google Scholar] conducted a systematic review and meta-analysis of heparin-bonded circuits. Unfortunately, these surfaces have been either withdrawn from the market or replaced by new generations of biocompatible treatments, and as a result, most of the studies analyzed are dated 8 to 20 years ago. Moreover, concerns have been raised with respect to the selection criteria of their meta-analysis that led to the exclusion of some major studies [4Ranucci M. Clinical impact of heparin-bonded circuits: when a meta-analysis does not clear out the clouds.Eur J Cardiothorac Surg. 2008; 34: 703-704Crossref PubMed Scopus (2) Google Scholar]. This article is a systematic review and meta-analysis of the relevant RCTs comparing biocompatible surfaces with conventional systems. The aim of this review is to determine whether biocompatible circuits exert a beneficial effect on the clinical outcome of patients undergoing cardiac operations in terms of reducing morbidity, mortality, and resource utilization. The present study was conducted in line with recommendations from the Cochrane Collaboration and the quality of reporting of meta-analyses (QUOROM) guidelines [5Alderson P. Green S. Higgins J. Cochrane reviewers' handbook 4.2.5 ed (updated December 2005). John Wiley & Sons, Ltd, Chichester2005Google Scholar, 6Moher D. Cook D.J. Eastwood S. Olkin I. Rennie D. Stroup D.F. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement Quality of reporting of meta-analyses.Lancet. 1999; 354: 1896-1900Abstract Full Text Full Text PDF PubMed Scopus (3896) Google Scholar]. The following outcome variables have been extracted from the retrieved articles:•Packed red cells (PRCs) transfusions (rate of patients receiving at least 1 unit);•surgical revision due to postoperative bleeding;•perioperative myocardial infarction, defined per study using author definitions based on electrocardiographic and enzymatic criteria;•low cardiac output syndrome, defined as the need for major or prolonged inotropic support after the operation;•use of intraaortic balloon pump after the operation;•new onset atrial fibrillation (AF);•stroke, defined as focal neurologic injury documented by computed tomography scan;•lung dysfunction, defined in each study using author definitions;•gastroenteric complications, including gastric bleeding, pancreatitis, hepatic failure, and mesenteric infarction;•sepsis (systemic infection) according to the study definition;•mechanical ventilation time (hours);•intensive care unit (ICU) stay and postoperative hospital stay (days); and•hospital mortality. Postoperative bleeding was not included within the outcome variables due to the great variation among the different institutions with respect to the time frame for its evaluation (6, 12, or 24 postoperative hours). Categoric binary variables have been considered as the rate of events, and continuous variables (mechanical ventilation time, ICU and hospital length of stay) have been considered as mean ± standard deviation (SD) of the mean. When these variables were expressed as median and range, or other nonparametric measures, they were excluded from the meta-analysis. The following a priori criteria were established before initiating the article search: (1) only outcome measurements correctly assessed with the preestablished unit of measure in at least eight different studies were to be admitted to the general meta-analysis; and (2) a subgroup analysis for high-quality studies was planned. For this subgroup, only outcome measurements correctly assessed with the preestablished unit of measure in at least three different studies were to be admitted to the meta-analysis. Pertinent studies were independently searched by two trained investigators (MR, SB) and one independent researcher (AB) in BioMedCentral, CENTRAL, PubMed, PubMed Central, Scopus, and the Cochrane Library (updated May 1, 2008). The following key words were used: cardiopulmonary bypass, extracorporeal circulation, biocompatible treatment, heparin coated, heparin bonded, phosphorylcholine, PMEA, siloxane/caprolactone; poly(2-methoxyethylacrylate), polyethylene oxide, sulfate/sulfonate, trillium, X-coating, SMA coating, Duraflo II, and Carmeda. To conduct the research, we followed the strategy suggested by Biondi-Zoccai and coworkers [7Biondi-Zoccai G.G.L. Agostoni P. Abbate A. Testa L. Burzotta F. A simple hint to improve Robinson and Dickensin's highly sensitive PubMed search strategy for controlled clinical trials.Int J Epidemiol. 2005; 34: 224-225Crossref PubMed Scopus (111) Google Scholar]. Further searches, either manual or computer-assisted, involved the recent (from the year 2002) proceedings and abstracts from congresses of the following scientific associations: American Thoracic Society; Society of Thoracic Surgeons; Society of Cardiovascular Anesthesiologist, European Association of Cardiothoracic Anaesthesiologists; and American College of Chest Physicians. In addition, retrieved articles and pertinent reviews references were scanned, and international experts were contacted and interviewed. No ongoing trials were included. An initial selection of the references obtained by the search was performed by two independent investigators (MR and AB) on the basis of title and abstract; divergence was resolved by consensus. If considered pertinent, the studies were retrieved as complete articles. The following inclusion criteria were applied for selecting potentially relevant studies: (1) prospective studies with random allocation to treatment (RCTs), (2) comparison of a biocompatible treatment of any kind vs untreated circuit and oxygenator of the same type, or (3) studies performed in patients undergoing cardiac surgical procedures. Exclusion criteria were (1) duplicate publications (in this case only the article reporting the larger patient population was considered), (2) pediatric patients (ω12 years old), (3) nonhuman experiments, (4) outcome data or outcome data reported with intractable units of measure, or (5) three or more study arms. This last exclusion criterion was decided on due to the impossibility of a homogeneous comparison with respect to the oxygenator type because of the very high risk of selection bias in randomization and performance bias due to the impossible blinding of the study. The selected studies (Table 1) [1Wildevuur C.R. Jansen P.G. Bezemer P.D. et al.Clinical evaluation of Duraflo II heparin treated extracorporeal circulation circuits (2nd version) The European Working Group on heparin coated extracorporeal circulation circuits.Eur J Cardiothorac Surg. 1997; 11: 616-623Crossref PubMed Scopus (58) Google Scholar, 2Ranucci M. Mazzucco A. Pessotto R. et al.Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial.Ann Thorac Surg. 1999; 67: 994-1000Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, 8de Somer F. Van B.Y. Caes F. et al.Phosphorylcholine coating offers natural platelet preservation during cardiopulmonary bypass.Perfusion. 2002; 17: 39-44Crossref PubMed Scopus (44) Google Scholar, 9Kreisler K.R. Vance R.A. Cruzzavala J. Mahnken J.D. Heparin-bonded cardiopulmonary bypass circuits reduce the rate of red blood cell transfusion during elective coronary artery bypass surgery.J Cardiothorac Vasc Anesth. 2005; 19: 608-611Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 10Baufreton C. Le Besnerais P. Jansen P. Mazzucotelli J.P. Wildevuur C.R. Loisance D.Y. Clinical outcome after coronary surgery with heparin-coated extracorporeal circuits for cardiopulmonary bypass.Perfusion. 1996; 11: 437-443Crossref PubMed Scopus (17) Google Scholar, 11Dickinson T. Mahoney C.B. Simmons M. Marison A. Polanski P. Trillium-coated oxygenators in adult open-heart surgery: a prospective randomized trial.J Extra Corpor Technol. 2002; 34: 248-253PubMed Google Scholar, 12Gunaydin S. Mccusker K. Vijay V. Clinical performance and biocompatibility of novel hyaluronan-based heparin-bonded extracorporeal circuits.J Extra Corpor Technol. 2005; 37: 290-295PubMed Google Scholar, 13Gunaydin S. Farsak B. Kocakulak M. Sari T. Yorgancioglu C. Zorlutuna Y. Clinical performance and biocompatibility of poly(2-methoxyethylacrylate)-coated extracorporeal circuits.Ann Thorac Surg. 2002; 74: 819-824Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 14Heyer E.J. Lee K.S. Manspeizer H.E. et al.Heparin-bonded cardiopulmonary bypass circuits reduce cognitive dysfunction.J Cardiothorac Vasc Anesth. 2002; 16: 37-42Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 15Khosravi A. Skrabal C.A. Westphal B. et al.Evaluation of coated oxygenators in cardiopulmonary-bypass systems and their impact on neurocognitive function.Perfusion. 2005; 20: 249-254Crossref PubMed Scopus (5) Google Scholar, 16Mahoney C.B. Lemole G.M. Transfusion after coronary artery bypass surgery: the impact of heparin-bonded circuits.Eur J Cardiothorac Surg. 1999; 16: 206-210Crossref PubMed Scopus (24) Google Scholar, 17McCarthy P.M. Yared J.P. Foster R.C. Ogella D.A. Borsh J.A. Cosgrove 3rd, D.M. A prospective randomized trial of Duraflo II heparin-coated circuits in cardiac reoperations.Ann Thorac Surg. 1999; 67: 1268-1273Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 18Muehrcke D.D. McCarthy P.M. Kottke-Marchant K. et al.Biocompatibility of heparin-coated extracorporeal bypass circuits: a randomized, masked clinical trial.J Thorac Cardiovasc Surg. 1996; 112: 472-483Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 19Ninomiya M. Miyaji K. Takamoto S. Influence of PMEA-coated bypass circuits on perioperative inflammatory response.Ann Thorac Surg. 2003; 75 (7; discussion 917–8): 913Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 20Pappalardo F. Della Valle P. Crescenzi G. et al.Phosphorylcholine coating may limit thrombin formation during high-risk cardiac surgery: a randomized controlled trial.Ann Thorac Surg. 2006; 81: 886-891Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 21Sudkamp M. Mehlhorn U. Reza Raji M. et al.Cardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery.Thorac Cardiovasc Surg. 2002; 50: 5-10Crossref PubMed Scopus (6) Google Scholar, 22Vang S.N. Brady C.P. Christensen K.A. Isler J.R. Allen K.R. Clinical evaluation of poly(2-methoxyethylacrylate) in primary coronary artery bypass grafting.J Extra Corpor Technol. 2005; 37: 23-31PubMed Google Scholar, 23Belboul A. al-Khaja N. Does heparin coating improve biocompatibility? A study on complement, blood cells and postoperative morbidity during cardiac surgery.Perfusion. 1997; 12: 385-391Crossref PubMed Scopus (34) Google Scholar, 24Boonstra P.W. Gu Y.J. Akkerman C. Haan J. Huyzen R. van Oeveren W. Heparin coating of an extracorporeal circuit partly improves hemostasis after cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1994; 107: 289-292PubMed Google Scholar, 25Butler J. Murithi E.W. Pathi V.L. MacArthur K.J. Berg G.A. Duroflo II heparin bonding does not attenuate cytokine release or improve pulmonary function.Ann Thorac Surg. 2002; 74: 139-142Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 26de Vroege R. van Oeveren W. van Klarenbosch J. et al.The impact of heparin-coated cardiopulmonary bypass circuits on pulmonary function and the release of inflammatory mediators.Anesth Analg. 2004; 98: 1586-1594Crossref PubMed Scopus (47) Google Scholar, 27Jansen P.G. Baufreton C. Le Besnerais P. Loisance D.Y. Wildevuur C.R. Heparin-coated circuits and aprotinin prime for coronary artery bypass grafting.Ann Thorac Surg. 1996; 61: 1363-1366Abstract Full Text PDF PubMed Scopus (45) Google Scholar, 28Jansen P.G. te Velthuis H. Huybregts R.A. et al.Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuits.J Thorac Cardiovasc Surg. 1995; 110: 829-834Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar, 29Oliver Jr, W.C. Nuttall G.A. Ereth M.H. Santrach P.J. Buda D.A. Schaff H.V. Heparin-coated versus uncoated extracorporeal circuit in patients undergoing coronary artery bypass graft surgery.J Cardiothorac Vasc Anesth. 2003; 17: 165-170Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 30Parolari A. Alamanni F. Gherli T. et al.‘High dose’ aprotinin and heparin-coated circuits: Clinical efficacy and inflammatory response.Cardiovasc Surg. 1999; 7: 117-127Crossref PubMed Scopus (12) Google Scholar, 31Svenmarker S. Sandstrom E. Karlsson T. et al.Clinical effects of the heparin coated surface in cardiopulmonary bypass.Eur J Cardiothorac Surg. 1997; 11: 957-964Crossref PubMed Scopus (57) Google Scholar, 32Saenz A. Larranaga G. Alvarez L. et al.Heparin-coated circuit in coronary surgery A clinical study.Eur J Cardiothorac Surg. 1996; 10: 48-53Crossref PubMed Scopus (20) Google Scholar, 33Wan S. LeClerc J.L. Antoine M. DeSmet J.M. Yim A.P. Vincent J.L. Heparin-coated circuits reduce myocardial injury in heart or heart-lung transplantation: a prospective, randomized study.Ann Thorac Surg. 1999; 68: 1230-1235Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 34Aldea G.S. Doursounian M. O'Gara P. et al.Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study.Ann Thorac Surg. 1996; 62 (discussion 417–8): 410-417Abstract Full Text PDF PubMed Scopus (41) Google Scholar, 35Inui K. Shimazaki Y. Watanabe T. et al.Effects of Duraflo II heparin-coated cardiopulmonary bypass circuits on the coagulation system, endothelial damage, and cytokine release in patients with cardiac operation employing aprotinin and steroids.Artif Organs. 1999; 23: 1107-1112Crossref PubMed Scopus (15) Google Scholar, 36Videm V. Mollnes T.E. Bergh K. et al.Heparin-coated cardiopulmonary bypass equipment II. mechanisms for reduced complement activation in vivo.J Thorac Cardiovasc Surg. 1999; 117: 803-809Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar, 37Belboul A. Akbar O. Lofgren C. Jungbeck M. Storm C. Roberts A. Improved blood cellular biocompatibility with heparin coated circuits during cardiopulmonary bypass.J Cardiovasc Surg (Torino). 2000; 41: 357-362PubMed Google Scholar, 38Collart F. Caus T. Pomane C. et al.Clinical evaluation of heparin-coated circuits for routine coronary artery bypass grafting surgery: a prospective randomized study.Artif Organs. 2000; 24: 611-613Crossref PubMed Scopus (9) Google Scholar, 39Hamulu A. Discigil B. Ozbaran M. et al.Complement consumption during cardiopulmonary bypass: comparison of Duraflo II heparin-coated and uncoated circuits in fully heparinized patients.Perfusion. 1996; 11: 333-337Crossref PubMed Scopus (7) Google Scholar, 40Wagner W.R. Johnson P.C. Thompson K.A. Marrone G.C. Heparin-coated cardiopulmonary bypass circuits: hemostatic alterations and postoperative blood loss.Ann Thorac Surg. 1994; 58 (40; discussion 741): 734Abstract Full Text PDF PubMed Scopus (72) Google Scholar, 41Borowiec J. Thelin S. Bagge L. Hultman J. Hansson H.E. Decreased blood loss after cardiopulmonary bypass using heparin-coated circuit and 50% reduction of heparin dose.Scand J Thorac Cardiovasc Surg. 1992; 26: 177-185Crossref PubMed Scopus (68) Google Scholar] were independently decided on by two investigators (MR and AB), with divergence finally resolved by consensus.Table 1Selected StudiesStudy (First Author)YearBiocompatible TreatmentaBiocompatible treatments: A = heparin-bonded (ionic or covalent or other kind of bonding); B = poly(2-methoxyethylacrylate); C = phosphorylcholine; D = siloxane/caprolactone; E = heparin, polyethylene oxide chains, sulfate/sulfonate groups.Jadad Quality ScoreOutcome MeasurementsbOutcome measurements: 1 = packed red cells transfusion; 2 = surgical revision; 3 = perioperative myocardial infarction; 4 = low cardiac output syndrome; 5 = atrial fibrillation; 6 = use of intraaortic balloon pump; 7 = stroke; 8 = lung dysfunction; 9 = acute renal failure; 10 = gastroenteric complications; 11 = sepsis; 12 = mechanical ventilation time; 13 = intensive care unit stay; 14 = hospital stay; 15 = death.Wildevuur [1Wildevuur C.R. Jansen P.G. Bezemer P.D. et al.Clinical evaluation of Duraflo II heparin treated extracorporeal circulation circuits (2nd version) The European Working Group on heparin coated extracorporeal circulation circuits.Eur J Cardiothorac Surg. 1997; 11: 616-623Crossref PubMed Scopus (58) Google Scholar]1997A-ionic41, 2, 3, 5, 6, 7, 8, 9, 10, 15Ranucci [2Ranucci M. Mazzucco A. Pessotto R. et al.Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial.Ann Thorac Surg. 1999; 67: 994-1000Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar]1999A-ionic11, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14de Somer [8de Somer F. Van B.Y. Caes F. et al.Phosphorylcholine coating offers natural platelet preservation during cardiopulmonary bypass.Perfusion. 2002; 17: 39-44Crossref PubMed Scopus (44) Google Scholar]2002C11Kreisler [9Kreisler K.R. Vance R.A. Cruzzavala J. Mahnken J.D. Heparin-bonded cardiopulmonary bypass circuits reduce the rate of red blood cell transfusion during elective coronary artery bypass surgery.J Cardiothorac Vasc Anesth. 2005; 19: 608-611Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar]2005A-covalent31, 12, 13, 14Baufreton [10Baufreton C. Le Besnerais P. Jansen P. Mazzucotelli J.P. Wildevuur C.R. Loisance D.Y. Clinical outcome after coronary surgery with heparin-coated extracorporeal circuits for cardiopulmonary bypass.Perfusion. 1996; 11: 437-443Crossref PubMed Scopus (17) Google Scholar]1996A-ionic21, 2, 3, 5, 8, 9, 11, 15Dickinson [11Dickinson T. Mahoney C.B. Simmons M. Marison A. Polanski P. Trillium-coated oxygenators in adult open-heart surgery: a prospective randomized trial.J Extra Corpor Technol. 2002; 34: 248-253PubMed Google Scholar]2002E21, 2, 5, 6, 7, 8, 12, 13, 14, 15Gunaydin [12Gunaydin S. Mccusker K. Vijay V. Clinical performance and biocompatibility of novel hyaluronan-based heparin-bonded extracorporeal circuits.J Extra Corpor Technol. 2005; 37: 290-295PubMed Google Scholar]2005A112, 13, 14, 15Gunaydin [13Gunaydin S. Farsak B. Kocakulak M. Sari T. Yorgancioglu C. Zorlutuna Y. Clinical performance and biocompatibility of poly(2-methoxyethylacrylate)-coated extracorporeal circuits.Ann Thorac Surg. 2002; 74: 819-824Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar]2002B05, 12, 13, 14, 15Heyer [14Heyer E.J. Lee K.S. Manspeizer H.E. et al.Heparin-bonded cardiopulmonary bypass circuits reduce cognitive dysfunction.J Cardiothorac Vasc Anesth. 2002; 16: 37-42Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar]2002A-others13, 7, 13, 14, 15Khosravi [15Khosravi A. Skrabal C.A. Westphal B. et al.Evaluation of coated oxygenators in cardiopulmonary-bypass systems and their impact on neurocognitive function.Perfusion. 2005; 20: 249-254Crossref PubMed Scopus (5) Google Scholar]2005C17, 12, 13, 15Mahoney [16Mahoney C.B. Lemole G.M. Transfusion after coronary artery bypass surgery: the impact of heparin-bonded circuits.Eur J Cardiothorac Surg. 1999; 16: 206-210Crossref PubMed Scopus (24) Google Scholar]1999A-covalent11, 2, 3, 8, 9, 14, 15McCarthy [17McCarthy P.M. Yared J.P. Foster R.C. Ogella D.A. Borsh J.A. Cosgrove 3rd, D.M. A prospective randomized trial of Duraflo II heparin-coated circuits in cardiac reoperations.Ann Thorac Surg. 1999; 67: 1268-1273Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar]1999A-ionic41, 2, 12, 13, 14, 15Muehrcke [18Muehrcke D.D. McCarthy P.M. Kottke-Marchant K. et al.Biocompatibility of heparin-coated extracorporeal bypass circuits: a randomized, masked clinical trial.J Thorac Cardiovasc Surg. 1996; 112: 472-483Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar]1996A-ionic41, 3, 6, 7, 8, 11, 15Ninomiya [19Ninomiya M. Miyaji K. Takamoto S. Influence of PMEA-coated bypass circuits on perioperative inflammatory response.Ann Thorac Surg. 2003; 75 (7; discussion 917–8): 913Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar]2003B11, 12, 13, 15Pappalardo [20Pappalardo F. Della Valle P. Crescenzi G. et al.Phosphorylcholine coating may limit thrombin formation during high-risk cardiac surgery: a randomized controlled trial.Ann Thorac Surg. 2006; 81: 886-891Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar]2006C31, 2Sudkamp [21Sudkamp M. Mehlhorn U. Reza Raji M. et al.Cardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery.Thorac Cardiovasc Surg. 2002; 50: 5-10Crossref PubMed Scopus (6) Google Scholar]2002D32, 3, 6, 7, 12, 13, 15Vang [22Vang S.N. Brady C.P. Christensen K.A. Isler J.R. Allen K.R. Clinical evaluation of poly(2-methoxyethylacrylate) in primary coronary artery bypass grafting.J Extra Corpor Technol. 2005; 37: 23-31PubMed Google Scholar]2005B315Belboul [23Belboul A. al-Khaja N. Does heparin coating improve biocompatibility? A study on complement, blood cells and postoperative morbidity during cardiac surgery.Perfusion. 1997; 12: 385-391Crossref PubMed Scopus (34) Google Scholar]1997A-covalent13, 7, 12Boonstra [24Boonstra P.W. Gu Y.J. Akkerman C. Haan J. Huyzen R. van Oeveren W. Heparin coating of an extracorporeal circuit partly improves hemostasis after cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1994; 107: 289-292PubMed Google Scholar]1994A-ionic12Butler [25Butler J. Murithi E.W. Pathi V.L. MacArthur K.J. Berg G.A. Duroflo II heparin bonding does not attenuate cytokine release or improve pulmonary function.Ann Thorac Surg. 2002; 74: 139-142Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar]2002A-ionic212de Vroege [26de Vroege R. van Oeveren W. van Klarenbosch J. et al.The impact of heparin-coated cardiopulmonary bypass circuits on pulmonary function and the release of inflammatory mediators.Anesth Analg. 2004; 98: 1586-1594Crossref PubMed Scopus (47) Google Scholar]2004A-others32, 12, 13Jansen [27Jansen P.G. Baufreton C. Le Besnerais P. Loisance D.Y. Wildevuur C.R. Heparin-coated circuits and aprotinin prime for coronary artery bypass grafting.Ann Thorac Surg. 1996; 61: 1363-1366Abstract Full Text PDF PubMed Scopus (45) Google Scholar]1996A-ionic31, 2, 3, 5, 7, 8, 15Jansen [28Jansen P.G. te Velthuis H. Huybregts R.A. et al.Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuits.J Thorac Cardiovasc Surg. 1995; 110: 829-834Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar]1995A-ionic312, 15Oliver [29Oliver Jr, W.C. Nuttall G.A. Ereth M.H. Santrach P.J. Buda D.A. Schaff H.V. Heparin-coated versus uncoated extracorporeal circuit in patients undergoing coronary artery bypass graft surgery.J Cardiothorac Vasc Anesth. 2003; 17: 165-170Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar]2003A-ionic01, 2Parolari [30Parolari A. Alamanni F. Gherli T. et al.‘High dose’ aprotinin and heparin-coated circuits: Clinical efficacy and inflammatory response.Cardiovasc Surg. 1999; 7: 117-127Crossref PubMed Scopus (12) Google Scholar]1999A-ionic21, 3, 7, 12, 13Svenmarker [31Svenmarker S. Sandstrom E. Karlsson T. et al.Clinical effects of the heparin coated surface in cardiopulmonary bypass.Eur J Cardiothorac Surg. 1997; 11: 957-964Crossref PubMed Scopus (57) Google Scholar]1997A-covalent41, 4, 12, 14Saenz [32Saenz A. Larranaga G. Alvarez L. et al.Heparin-coated circuit in coronary surgery A clinical study.Eur J Cardiothorac Surg. 1996; 10: 48-53Crossref PubMed Scopus (20) Google Scholar]1996A-covalent11, 2, 3, 7, 10, 12, 14, 15Wan [33Wan S. LeClerc J.L. Antoine M. DeSmet J.M. Yim A.P. Vincent J.L. Heparin-coated circuits reduce myocardial injury in heart or heart-lung transplantation: a prospective, randomized study.Ann Thorac Surg. 1999; 68: 1230-1235Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar]1999A-ionic22, 15Aldea [34Aldea G.S. Doursounian M. O'Gara P. et al.Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study.Ann Thorac Surg. 1996; 62 (discussion 417–8): 410-417Abstract Full Text PDF PubMed Scopus (41) Google Scholar]1996A–both31, 2, 3, 4, 5, 7, 8, 10, 11, 12, 13, 14, 15Inui [35Inui K. Shimazaki Y. Watanabe T. et al.Effects of Duraflo II heparin-coated cardiopulmonary bypass circuits on the coagulation system, endothelial damage, and cytokine release in patients with cardiac operation employing aprotinin and steroids.Artif Organs. 1999; 23: 1107-1112Crossref PubMed Scopus (15) Google Scholar]1999A-ionic11Videm [36Videm V. Mollnes T.E. Bergh K. et al.Heparin-coated cardiopulmonary bypass equipment II. mechanisms for reduced complement activation in vivo.J Thorac Cardiovasc Surg. 1999; 117: 803-809Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar]1999A-ionic12, 8, 9, 10, 11, 15Belboul [37Belboul A. Akbar O. Lofgren C. Jungbeck M. Storm C. Roberts A. Improved blood cellular biocompatibility with heparin coated circuits during cardiopulmonary bypass.J Cardiovasc Surg (Torino). 2000; 41: 357-362PubMed Google Scholar]2000A-ionic15, 12, 13, 14Collart [38Collart F. Caus T. Pomane C. et al.Clinical evaluation of heparin-coated circuits for routine coronary artery bypass grafting surgery: a prospective randomized study.Artif Organs. 2000; 24: 611-613Crossref PubMed Scopus (9) Google Scholar]2000A-covalent11," @default.
• W1981966246 created "2016-06-24" @default.
• W1981966246 creator A5007850230 @default.
• W1981966246 creator A5009489695 @default.
• W1981966246 creator A5013683555 @default.
• W1981966246 creator A5075056152 @default.
• W1981966246 creator A5076475941 @default.
• W1981966246 date "2009-04-01" @default.
• W1981966246 modified "2023-09-24" @default.
• W1981966246 title "A Systematic Review of Biocompatible Cardiopulmonary Bypass Circuits and Clinical Outcome" @default.
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