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Ann Thorac Surg 2007;83:1760-1766
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Attenuated Renal and Intestinal Injury After Use of a Mini-Cardiopulmonary Bypass System

Rien A.J.M. Huybregts, MDa, Aurora M. Morariu, MD, PhDc, Gerhard Rakhorst, PhDc, Stefan R. Spiegelenberg, MDa, Hans W.A. Romijn, MDb, Roel de Vroege, PhDa, Willem van Oeveren, PhDc,*

a Department of Cardiothoracic Surgery, Free University Medical Center, Amsterdam
b Department of Anesthesiology, Free University Medical Center, Amsterdam
c Department of Biomedical Engineering/Artificial Organs, University Medical Center, Groningen, the Netherlands

Accepted for publication February 7, 2007.

* Address correspondence to Dr van Oeveren, Department of Biomedical Engineering and Anesthesiology, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands (Email: w.van.oeveren{at}med.umcg.nl).

Background: Transient, subclinical myocardial, renal, intestinal, and hepatic tissue injury and impaired homeostasis is detectable even in low-risk patients undergoing conventional cardiopulmonary bypass (CPB). Small extracorporeal closed circuits with low priming volumes and optimized perfusion have been developed to reduce deleterious effects of CPB.

Methods: A prospective, randomized trial was conducted in 49 patients undergoing elective coronary artery bypass graft surgery either with the use of a standard or mini-CPB system (Synergy). We determined early postoperative inflammatory response (leukocytosis, C-reactive protein, urine interleukin-6), platelet consumption and activation (urine thromboxane B2), proximal renal tubular injury (urine N-acetyl-glucosaminidase), and intestinal injury (intestinal fatty acid binding protein).

Results: In patients undergoing coronary artery bypass grafting with a mini-CPB system, we observed decreased priming volumes with subsequent attenuation of on-pump hemodilution, improved hemostatic status with reduced platelet consumption and platelet activation, decreased postoperative bleeding and minimized transfusion requirements. We also found reduced leukocytosis and decreased urinary interleukin-6. Levels of urine N-acetyl-glucosaminidase were on average threefold lower, and urinary intestinal fatty acid binding protein was 40% decreased in the patients on the mini-CPB system, as compared with standard CPB.

Conclusions: The use of the mini-CPB system during myocardial revascularization represents a viable nonpharmacologic strategy that can attenuate the alterations in the hemostatic system, reduce bleeding and transfusion requirements, decrease systemic inflammatory response, and reduce immediate postoperative renal and intestinal tissue injury.


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Invited Commentary
Michael Jessen
Ann. Thorac. Surg. 2007 83: 1766-1767. [Extract] [Full Text] [PDF]



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M. Jessen
Invited Commentary
Ann. Thorac. Surg., May 1, 2007; 83(5): 1766 - 1767.
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