Blood-Surface Interactions During Cardiopulmonary Bypass
| Autor: | L. Henry Edmunds, S Niewiarowski, Robert W. Colman |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Blood Platelets
Pulmonary and Respiratory Medicine medicine.medical_specialty Surface Properties Fibrinogen receptor Inflammatory response law.invention law Internal medicine Cardiopulmonary bypass Humans Medicine Inflammation Cardiopulmonary Bypass business.industry Extracorporeal circulation Thrombosis Blood Physiological Phenomena Platelet Activation Surgery Endothelial stem cell Factor XII Cardiology Bleeding problems Cardiology and Cardiovascular Medicine business Whole body |
| Zdroj: | Journal of Cardiac Surgery. 8:404-410 |
| ISSN: | 1540-8191 0886-0440 |
| Popis: | The interaction between blood and the synthetic surfaces of the heart-lung machine activates plasma protein systems and blood cells to produce a host of vasoactive substances that mediate the "whole body inflammatory response" associated with cardiopulmonary bypass (CPB). Plasma proteins are instantaneously adsorbed onto nonendothelial surfaces; plasma factor XII is cleaved into two serine proteases; and platelets are activated to aggregate, adhere to adsorbed fibrinogen, and release granule contents. Activation of factor XII initiates coagulation by the intrinsic coagulation pathway and activates complement. Complement stimulates neutrophils to release vasoactive and cytotoxic substances. Endothelial cells, perhaps stimulated by formation of minute quantities of thrombin, produce tissue plasminogen activator, which generates plasmin, a fibrolytic enzyme. Blood becomes a stew of powerful enzymes and chemicals that alters vascular smooth muscle and endothelial cell contraction. Capillary permeability increases, fluid is retained, and function of essentially every organ is temporarily impaired. Attempts to control the morbidity of CPB have focused on reversible inhibitors of specific reactions in blood. Prostanoids and new disintegrins are promising platelet inhibitors that are reversible. Aprotinin and other serine protease inhibitors partially control fibrinolysis and activation of neutrophils. Alternatives to heparin also show promise. Eventually control of the interaction of blood and synthetic surfaces will control the adverse reactions of the heart-lung machine and reduce the bleeding, thrombotic and inflammatory complications of open heart operations. |
| Databáze: | OpenAIRE |
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