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A clinical, renal and immunological assessment of Surface Modifying Additive Treated (SMART^TM) cardiopulmonary bypass circuits

Department of Clinical Anaesthesia, The Royal Group of Hospitals Trust, Belfast, Northern Ireland, jsdallen{at}yahoo.com

William T McBride

Department of Anaesthetics and Intensive Care Medicine, The Queen’s University of Belfast, Belfast, Northern Ireland

Ian S Young

Department of Medicine, The Queen’s University of Belfast, Belfast, Northern Ireland

Simon W MacGowan

Department of Cardiac Surgery, The Royal Group of Hospitals Trust, Belfast, Northern Ireland

Terence J McMurray

Department of Anaesthetics and Intensive Care Medicine, The Queen’s University of Belfast, Belfast, Northern Ireland

Sachin Prabhu

Royal Group of Hospitals, Belfast, Northern Ireland

S Prasad Penugonda

Royal Group of Hospitals, Belfast, Northern Ireland

Marilyn A Armstrong

Department of Microbiology and Immunobiology, The Queen’s University of Belfast, Belfast, Northern Ireland

Biocompatible cardiopulmonary bypass (CPB) circuits aim to reduce contact activation and its physiological consequences. We investigated the hypothesis that use of Surface Modifying Additive (SMA)-treated circuits (Sorin Group Ltd) compared with non-SMA circuits would be associated with preservation of blood pressure during CPB and modulation of perioperative subclinical renal function (urinary -1-microglobulin (-1-m)) and plasma and urinary cytokine changes. In a study of low-risk CABG patients (n=40), randomized to SMA (n=20) versus non-SMA circuits (n=20), we found better preserved blood pressure at CPB initiation in SMA patients (p <0.05), particularly in ACE-inhibited SMA patients (n=11) versus ACE-inhibited non-SMA patients (n=10) (p <0.05). Plasma anti-inflammatory IL-10, as well as urinary -1-m, were elevated 48 hours postoperatively (p <0.05). SMA patients also had lower blood loss (p <0.05). SMA circuits have some clinical benefit, especially in ACE-inhibited patients.

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