Ann Thorac Surg 2006;81:791
© 2006 The Society of Thoracic Surgeons
Correspondence
Reply
Anders Jeppsson, MD, PhD
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE 413 45 Gothenburg, Sweden
(Email: anders.jeppsson{at}vgregion.se).
To the Editor:
We thank Dr Baufreton [1] for his interest in our study [2] and his constructive comments. Baufreton states in his letter that it is amazing that we did not pay attention to cardiotomy suction and the use of centrifugal pumps in our study. This is a misunderstanding. In our study we compared cardiopulmonary bypass (CPB) biocompatibility of a closed heparin-coated system with a centrifugal pump, with a conventional open uncoated system with roller pump [2]. In contrast to most studies in the field, we chose to include only patients in which the inflammatory and hemostatic activation could be expected to be significant. We reasoned that the potential effects of a more biocompatible system would become more obvious with this design than if we had included low-risk patients. Therefore, we included only elderly patients with an expected CPB time of over 90 minutes in the study and intentionally allowed unlimited cardiotomy suction in all patients. We agree with Baufreton that cardiotomy suction is one important determinant of CPB biocompatibility and have recently presented a study that supports this view [3].
The question whether a centrifugal pump improves biocompatibility or not, is less clear than Baufreton indicates in his letter. Baufreton refers to his own study and the study by Ashraf and colleagues but does not mention the works by, eg, Morgan and colleagues [4], Andersen and colleagues [5], or Wheeldon and colleagues [6], all of which demonstrate improved biocompatibility with centrifugal pumps. In the study by Moen and colleagues [7] that we refer to in our manuscript, centrifugal pumps caused less hemolysis than the roller pump, indicating an improved biocompatibility.
As clearly stated in our publication [2], one apparent limitation of our study is that the design did not allow us to evaluate the role of the individual components of the bypass system. Future studies, preferably in high-risk patients with an increased inflammatory and hemostatic activation, are needed to determine the true value of individual measures.
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References
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- Baufreton C. More biocompatibility in cardiopulmonary bypass for high-risk patients (letter) Ann Thorac Surg 2006;81:790-791.[Free Full Text]
- Lindholm L, Westerberg M, Bengtsson A, Ekroth R, Jensen E, Jeppsson A. A closed perfusion system with heparin-coating and centrifugal pump improves cardiopulmonary bypass biocompatibility in elderly patients Ann Thorac Surg 2004;78:2131-2138.[Abstract/Free Full Text]
- Westerberg M, Bengtsson A, Jeppsson A. Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response Ann Thorac Surg 2004;78:54-59.[Abstract/Free Full Text]
- Morgan IS, Codispoti M, Sanger K, Mankad PS. Superiority of centrifugal pump over roller pump in paediatric cardiac surgeryprospective randomised trial. Eur J Cardiothorac Surg 1998;13:526-532.
- Andersen KS, Nygreen EL, Grong K, Leirvaag B, Holmsen H. Comparison of the centrifugal and roller pump in elective coronary artery bypass surgery—a prospective, randomized study with special emphasis upon platelet activation Scand Cardiovasc J 2003;37:356-362.[Medline]
- Wheeldon DR, Bethune DW, Gill RD. Vortex pumping for routine cardiac surgerya comparative study. Perfusion 1990;5:135-143.[Medline]
- Moen O, Fosse E, Dregelid E, et al. Centrifugal pump and heparin coating improves cardiopulmonary bypass biocompatibility Ann Thorac Surg 1996;62:1134-1140.[Abstract/Free Full Text]
Related Article
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More Biocompatibility in Cardiopulmonary Bypass for High-Risk Patients
- Christophe Baufreton
Ann. Thorac. Surg. 2006 81: 790-791.
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