Effects of Pulsatile Flow on Phosphorylcholine Coated Oxygenator and Arterial Filter

Year 2022, Issue: 34, 793 - 799, 31.03.2022

Gökhan Keskin , A. Tulga Ulus Tuna Güray Ece Ürpermez Sertan Özyalçın Orhan Erdem Haberal , Mustafa Kocakulak

https://doi.org/10.31590/ejosat.1083112

Abstract

Objective: We aimed to compare the effects of pulsatile/nonpulsatile flow on phosphorylcholine coated (PC) oxygenator fibers, arterial filters by using scanning electron microscope (SEM).
Methods: Eleven patients were randomly divided into two groups, as; nonpulsatile and pulsatile flow groups (NP and P groups) by using PC oxygenators. The oxygenator fiber samples were examined under SEM to compare the thickness of absorbed blood proteins and amount of blood cells on the surface of oxygenators. Arterial filters were also analysed by SEM regarding the captured blood elements or particles.
Results: The mean fiber thickness from the axial images were calculated as 46.9m and 47.6 m at group P and NP respectively which is statistically insignificant. Evaluation of the blood samples that were extracted from the arterial filter bring out higher amount of fibrin network and blood cells on fibers at group NP.
Conclusion: We concluded that there is lesser amount of blood components on the fibers of arterial filter at pulsatile flow. Coating of oxygenators is beneficial in case of surface biocompatibility and pulsatile perfusion develops lower amount of blood elements on arterial filter.

Keywords

Pulsatil flow, Coated oxygenator, Arterial filter, Cardiopulmonary bypass, Biocompatibility

Supporting Institution

Destekleyen kurum yoktur.

Project Number

Yoktur.

Thanks

Dergi için editöre teşekkürlerimizi bildiririz.

Effects of Pulsatile Flow on Phosphorylcholine Coated Oxygenator and Arterial Filter

Abstract

Objective: We aimed to compare the effects of pulsatile/nonpulsatile flow on phosphorylcholine coated (PC) oxygenator fibers, arterial filters by using scanning electron microscope (SEM).
Methods: Eleven patients were randomly divided into two groups, as; nonpulsatile and pulsatile flow groups (NP and P groups) by using PC oxygenators. The oxygenator fiber samples were examined under SEM to compare the thickness of absorbed blood proteins and amount of blood cells on the surface of oxygenators. Arterial filters were also analysed by SEM regarding the captured blood elements or particles.
Results: The mean fiber thickness from the axial images were calculated as 46.9 m and 47.6 m at group P and NP respectively which is statistically insignificant. Evaluation of the blood samples that were extracted from the arterial filter bring out higher amount of fibrin network and blood cells on fibers at group NP.
Conclusion: We concluded that there is lesser amount of blood components on the fibers of arterial filter at pulsatile flow. Coating of oxygenators is beneficial in case of surface biocompatibility and pulsatile perfusion develops lower amount of blood elements on arterial filter.

Keywords

Pulsatile flow, Coated oxygenator, Arterial filter

Project Number

Yoktur.

References

• Abramov, D., Tamariz, M., Serrick, C. I., Sharp, E., Noel, D., Harwood, S., ... & Goldman, B. S. (2003). The influence of cardiopulmonary bypass flow characteristics on the clinical outcome of 1820 coronary bypass patients. The Canadian journal of cardiology, 19(3), 237-243.
• Aĝirbaşli, M. A., Song, J., Lei, F., Wang, S., Kunselman, A. R., Clark, J. B., ... & Ündar, A. (2014). Comparative effects of pulsatile and nonpulsatile flow on plasma fibrinolytic balance in pediatric patients undergoing cardiopulmonary bypass. Artificial organs, 38(1), 28-33.
• Alghamdi, A. A., & Latter, D. A. (2006). Pulsatile versus nonpulsatile cardiopulmonary bypass flow: an evidence‐based approach. Journal of cardiac surgery, 21(4), 347-354.
• Chiu, I. S., Chu, S. H., & Hung, C. R. (1984). Pulsatile flow during routine cardiopulmonary bypass. The Journal of Cardiovascular Surgery, 25(6), 530-536.
• De Leval, M., Hill, J. D., Mielke, H., Bramson, M. L., Smith, C., & Gerbode, F. (1972). Platelet kinetics during extracorporeal circulation. ASAIO Journal, 18(1), 355-357.
• De Somer, F., Van Belleghem, Y., Foubert, L., François, K., Dubrulle, F., De Wolf, D., & Van Nooten, G. (1960). In vivo evaluation of a phosphorylcholine coated cardiopulmonary bypass. Strategies for optimisation of paediatric cardiopulmonary bypass, 31(2), 241.
• Dunn, J., Kirsh, M. M., Harness, J., Carroll, M., Straker, J., & Sloan, H. (1974). Hemodynamic, metabolic, and hematologic effects of pulsatile cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery, 68(1), 138-147.
• Frering, B., Philip, I., Dehoux, M., Rolland, C., Langlois, J. M., & Desmonts, J. M. (1994). Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass. The Journal of thoracic and cardiovascular surgery, 108(4), 636-641.
• Gorbet, M. B., & Sefton, M. V. (2004). Biomaterial-associated thrombosis: roles of coagulation factors, complement, platelets and leukocytes. Biomaterials, 25(26), 5681-5703.
• Gourlay, T. (2001). Biomaterial development for cardiopulmonary bypass. Perfusion, 16(5), 381-390.
• Guan, Y., Palanzo, D., Kunselman, A., & Ündar, A. (2009). Evaluation of membrane oxygenators and reservoirs in terms of capturing gaseous microemboli and pressure drops. Artificial organs, 33(11), 1037-1043.
• Iwasaki, Y., Tojo, Y., Kurosaki, T., & Nakabayashi, N. (2003). Reduced adhesion of blood cells to biodegradable polymers by introducing phosphorylcholine moieties. Journal of Biomedical Materials Research Part A: An Official Journal of The Society for Biomaterials, The Japanese Society for Biomaterials, and The Australian Society for Biomaterials and the Korean Society for Biomaterials, 65(2), 164-169.
• Iwahashi, H., Yuri, K., & Nosé, Y. (2004). Development of the oxygenator: past, present, and future. Journal of Artificial Organs, 7(3), 111-120.
• Karakisi, S. O., Bozok, S., Sargon, M. F., Ergene, S., Ilhan, G., Karamustafa, H., ... & Musabak, U. (2016). Humoral immune response and coated or uncoated oxygenators during cardiopulmonary bypass surgery. Cardiovascular Journal of Africa, 27(4), 242-245.
• Kocakulak, M., Küçükaksu, S., & Pişkin, E. (2004). Pulsatile roller pump perfusion is safe in high risk patients. The International Journal of Artificial Organs, 27(5), 433-439.
• Kocakulak, M., Koçum, İ. C., & Ayhan, H. (2012). Investigation of inflammatory response at blood–poly (2-methoxyethyl acrylate)(PMEA) interface in vivo via scanning tunneling microscope. Journal of bioactive and compatible polymers, 27(1), 45-53.
• Kocakulak, M., Kocum, C., Saber, R., Ayhan, H., Günaydin, S., Sari, T., ... & Bingöl, N. (2002). Investigation of blood compatibility of PMEA coated extracorporeal circuits. Journal of bioactive and compatible polymers, 17(5), 343-356
• Kocakulak, M., Aşkin, G., Küçükaksu, S., Tarcan, O., & Pişkin, E. (2005). Pulsatile flow improves renal function in high-risk cardiac operations. Blood purification, 23(4), 263-267.
• Lim, C. H., Nam, M. J., Lee, J. S., Kim, H. J., Kim, J. Y., Shin, H. W., ... & Sun, K. (2015). A meta‐analysis of pulmonary function with pulsatile perfusion in cardiac surgery. Artificial Organs, 39(2), 110-117.
• Lorusso, R., De Cicco, G., Totaro, P., & Gelsomino, S. (2009). Effects of phosphorylcholine coating on extracorporeal circulation management and postoperative outcome: a double-blind randomized study. Interactive cardiovascular and thoracic surgery, 8(1), 7-11.
• Nam, M. J., Lim, C. H., Kim, H. J., Kim, Y. H., Choi, H., Son, H. S., ... & Sun, K. (2015). A meta‐analysis of renal function after adult cardiac surgery with pulsatile perfusion. Artificial organs, 39(9), 788-794. Pivush J., Wu Zhi, Andrew M., (2012). Effects Of CO2 Critical Point Drying On Nanostructured Sio2 Thin Films After Liquid Exposure, s;44-56
• Rabe, M., Verdes, D., & Seeger, S. (2011). Understanding protein adsorption phenomena at solid surfaces. Advances in colloid and interface science, 162(1-2), 87-106.
• Sezai, A., Shiono, M., Nakata, K. I., Hata, M., Iida, M., Saito, A., ... & Sezai, Y. (2005). Effects of pulsatile cpb on interleukin‐8 and endothelin‐1 levels. Artificial organs, 29(9), 708-713.
• Shah, P. J., Wu, Z., & Sarangan, A. M. (2013). Effects of CO2 critical point drying on nanostructured SiO2 thin films after liquid exposure. Thin solid films, 527, 344-348.
• Simons, A. P., Wortel, P., Van Kan, R. A., Van Der Veen, F. H., Weerwind, P. W., & Maessen, J. G. (2010). Pulse conductance and flow‐induced hemolysis during pulsatile cardiopulmonary bypass. Artificial organs, 34(4), 289-294.
• Sperling, C., Fischer, M., Maitz, M. F., & Werner, C. (2009). Blood coagulation on biomaterials requires the combination of distinct activation processes. Biomaterials, 30(27), 4447-4456.
• Tabesh, H., Amoabediny, G., Poorkhalil, A., Khachab, A., Kashefi, A., & Mottaghy, K. (2012). A theoretical model for evaluation of the design of a hollow-fiber membrane oxygenator. Journal of Artificial Organs, 15(4), 347-356.
• Tanaka, M., Motomura, T., Kawada, M., Anzai, T., Kasori, Y., Shiroya, T., ... & Mochizuki, A. (2000). Blood compatible aspects of poly (2-methoxyethylacrylate) (PMEA)—relationship between protein adsorption and platelet adhesion on PMEA surface. Biomaterials, 21(14), 1471-1481.
• Ündar, A., Rosenberg, G., & Myers, J. L. (2004). Impact of pulsatile flow on microcirculation. ASAIO journal, 50(6), 624-625.
• Ündar, A., & Moroi, M. K. (2019). Pulsatile flow is not a magic bullet for congenital heart surgery patients during CPB procedures. Artificial organs, 43(10), 943-946.
• Ündar, A. (2003). Energy equivalent pressure formula is for precise quantification of different perfusion modes. The Annals of thoracic surgery, 76(5), 1777-1778.
• Ündar, A., Ji, B., Lukic, B., Zapanta, C. M., Kunselman, A. R., Reibson, J. D., ... & Myers, J. L. (2006). Quantification of perfusion modes in terms of surplus hemodynamic energy levels in a simulated pediatric CPB model. ASAIO journal, 52(6), 712-717.
• Ündar, A., & Fraser Jr, C. D. (1999). Defining pulsatile perfusion: quantification in terms of energy equivalent pressure. Artificial organs, 23(8), 712-716.
• Warltier, D. C., Laffey, J. G., Boylan, J. F., & Cheng, D. C. (2002). The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. The Journal of the American Society of Anesthesiologists, 97(1), 215-252.
• Wendel, H. P., & Ziemer, G. (1999). Coating-techniques to improve the hemocompatibility of artificial devices used for extracorporeal circulation. European Journal of Cardio-Thoracic Surgery, 16(3), 342-350.