Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques

Abstract

To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR + MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24 h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A.

Low-Level Light Therapy Protects Red Blood Cells Against Oxidative Stress and Hemolysis During Extracorporeal Circulation

“…Hp late increase might be associated with an inflammatory reaction as it acts as a moderate acute-phase protein, however, when blood is hemolytic, determination by Hgb binding assays may give unreliable results ( Gruys et al, 2005 ). Our hemolytic parameters measurements are quite consistent with the results obtained by others ( Cirri et al, 2001 ; Mamikonian et al, 2014 ; Vermeulen Windsant et al, 2014 ; Baumbach et al, 2016 ). Sublethal RBC damage results in decreased deformability and surface charge, and increased fragility and aggregability ( Lee et al, 2007 ; Vercaemst, 2008 ) which subsequently lead to the early removal of the RBC from the circulation by the spleen or in the altered rheological proprieties of the blood followed by compromising efficient microcirculation and oxygen delivery to the surrounding tissues ( Watanabe et al, 2007 ; Vercaemst, 2008 ; Ciana et al, 2017 ).…”

Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

“…However, when comparing vacuum drainage with drainage by centrifugal pump, Cirri et al. [ 26 ] showed that the vacuum drainage causes higher degree of hemolysis, according conclusions confirmed by Gregoretti et al [ 27 ] . However, Lau et al [ 28 ] and Shin et al [ 24 ] disagree, showing similar levels of hemolysis.…”

Surgical, Anesthetic, Perfusion-Related Advances in Minimal Access Surgery

“…They found an increase in hemoglobinuria and a decreased platelet count in the VAVD group. Cirri et al 17 concluded that the red cell and platelet damage is reduced when the kinetic assist mode of venous drainage is used. The major disadvantage associated with KAVD is the entrainment of macrobubbles in the venous line, requiring manual clearing of the centrifugal pump.…”

“…17 The Medtronic Resting Heart System (Medtronic, Minneapolis, Minnesota) alleviates many of these issues providing safe and more efficient perfusion to our MIVS patients. Minimally invasive cardiac surgery itself is very demanding and challenging.…”