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Ann Thorac Surg 2004;78:2131-2138
© 2004 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery
b Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Accepted for publication June 2, 2004.
* Address reprint requests to Dr Jeppsson, Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE 413 45 Gothenburg, Sweden (E-mail: anders.jeppsson{at}vgregion.se).
Abstract
BACKGROUND: Cardiopulmonary bypass induces a systemic inflammatory and hemostatic activation, which may contribute to postoperative complications. Our aim was to compare the inflammatory response, coagulation, and fibrinolytic activation between two different perfusion systems: one theoretically more biocompatible with a closed-circuit, complete heparin coating, and a centrifugal pump, and one conventional system with uncoated circuit, roller pump, and a hard-shell venous reservoir.
METHODS: Forty-one elderly patients (mean age, 73 ± 1 years, 66% men) undergoing coronary artery bypass grafting or aortic valve replacement were included in a prospective, randomized study. Plasma concentrations of complement factors (C3a, C4d, Bb, and sC5b-9), proinflammatory cytokines (tumor necrosis factor-
, interleukin-6, and interleukin-8), granulocyte degradation products (polymorphonuclear elastase), and markers of coagulation (thrombin-antithrombin) and fibrinolysis (D-dimer, tissue plasminogen activator antigen and tissue plasminogen activator–plasminogen activator inhibitor-1 complex) were measured preoperatively, at bypass during rewarming (35°C), 60 minutes after bypass, and on day 1 after surgery.
RESULTS: The mean concentrations of C3a (–39%; p = 0.008), Bb (–38%; p < 0.001), sC5b-9 (–70%; p < 0.001), interleukin-8 (–60%; p = 0.009), polymorphonuclear-elastase (–55%; p < 0.003), and tissue plasminogen activator antigen (–51%; p = 0.012) were all significantly lower in the biocompatible group during rewarming. Sixty minutes after bypass, the mean concentrations of sC5b-9 (–39%; p = 0.006) and polymorphonuclear-elastase (–55%; p < 0.001) were lower in the biocompatible group.
CONCLUSIONS: The results suggest that a closed perfusion system with a heparin-coated circuit and a centrifugal pump may improve cardiopulmonary bypass biocompatibility in elderly cardiac surgery patients in comparison with a conventional system.
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Ann. Thorac. Surg. 2004 78: 2138.
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