Cardiovascular Journal of Africa: Vol 27 No 4 (July/August 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016 242 AFRICA
Humoral immune response and coated or uncoated
oxygenators during cardiopulmonary bypass surgery
Sedat Ozan Karakisi, Ayş e Gül Kunt, Şahin Bozok, İdil Çankaya, Mustafa Kocakulak, Uğur Mu şabak,
Mustafa Fevzi Sargon, Şaban Ergene, Gökhan İlhan, Hakan Karamustafa, NebiyeTufekci, Erol Şener
Abstract
Aim: To investigate and compare uncoated and phosphoryl-
choline-coated oxygenators in terms of induction of humoral
immune response during coronary artery bypass surgery.
Methods: A total of 20 consecutive patients who underwent
coronary artery bypass surgery were randomly distributed
into two groups according to the type of oxygenator used
during surgery. Group 1 consisted of 10 patients who were
operated on using phosphorylcholine-coated oxygenators.
Group 2 contained 10 patients who underwent surgery using
uncoated oxygenators. Blood and oxygenator fibre samples
were obtained and compared in terms of immunoglobulins
(IgG, IgM), complements (C3c, C4), serum total protein and
albumin levels using electron microscopy and flow cytometry.
Results: In group 1, levels of IgM, IgG, total protein and
serum albumin were significantly increased at the end of
cardiopulmonary bypass (CPB) compared to those at the
beginning of CPB. In group 2, C3c and C4 levels at the begin-
ning of CPB were found to be significantly higher than at the
end. Electron microscopic examination of oxygenator fibres
demonstrated that phosphorylcholine-coated fibres were less
likely to be adsorbed by serum proteins and complements
than the uncoated fibres.
Conclusion: Our results indicate that phosphorylcholine-coat-
ed oxygenators seemed to induce humoral immune response
to a lesser extent than uncoated oxygenators during coronary
artery bypass procedures.
Keywords: cardiopulmonary bypass, oxygenator, phosphorylcho-
line, humoral inflammation
Submitted 5/10/15, accepted 8/1/16
Cardiovasc J Afr 2016; 27: 242–245
DOI: 10.5830/CVJA-2016-003
Cardiopulmonarybypass (CPB) facilitates surgical procedures and
provides adequate perfusionof other organs during cardiovascular
surgery.1,2 Despite the advantages offered by CPB, a systemic
inflammatory response may arise due to multiple components of
the immune system, including cellular and humoral components.
This inflammation may arise from contact of circulating blood
cells with non-endothelial surfaces of extracorporeal circulation,
as well as from ischaemia/reperfusion injury, hypothermia and
other operative stresses.1,2 Cardiopulmonary and systemic hazards
may occur owing to the outcomes of this inflammatory response,
leading to morbidity and mortality.1,3
Modalities to manage this inflammatory response include medi-
cal agents such as steroids, complement inhibitors, monoclonal
antibodies and protease inhibitors. In addition to these medica-
tions, it has been suggested that lining the inner surfaces of extra-
corporeal circulation systems with a relatively inert material may
provide suppression of the immune response.4 The membranes of
oxygenators are important in this aspect since they are directly in
contact with the blood. Hence, coating these membranes is thought
to aid in decreasing the inflammatory response.4,5
The objective of this study was to compare phosphorylcholine-
coated and uncoated oxygenators in terms of the humoral immune
response triggered during cardiopulmonary bypass surgery.
Methods
This randomised, cross-sectional clinical study was performed in
the cardiovascular surgery department of a tertiary care centre.
Approval was obtained by the local institutional review board
(2010/12) and all patients gave written informed consent.
A total of 20 consecutive patients scheduled for CPB surgery
were included. During CPB, a phosphorylcholine-coated
oxygenator was used in 10 patients, constituting group 1, while
the uncoated oxygenator was used for the remaining 10 cases,
making up group 2. Participants were allocated to the two
study groups according to a computerised block-randomisation
process in order to keep the number of participants in the
different groups equal.
Department of Cardiovascular Surgery, Faculty of
Medicine, Recep Tayyip Erdogan University, Training and
Research Hospital, Rize, Turkey
Sedat Ozan Karakisi, MD
Şahin Bozok MD,
Şaban Ergene, MD
Gökhan İlhan, MD
Hakan Karamustafa, MD
NebiyeTufekci, MD
Department of Cardiovascular Surgery, Faculty of
Medicine, Yıldırım Beyazıd University, Atatürk Training and
Research Hospital, Ankara, Turkey
Ayşe Gül Kunt, MD
Erol Şener, MD
Department of Biomedical Engineering, Baskent
University, Ankara, Turkey
İdil Çankaya
Mustafa Kocakulak
Department of Immunology, Gulhane Military Medical
Academy and School of Medicine, Ankara, Turkey
Uğur Muşabak, MD
Department of Anatomy, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
Mustafa Fevzi Sargon, MD