Minimal cardiopulmonary bypass attenuates neutrophil activation and cytokine release in coronary artery bypass grafting

Abstract

The minimal cardiopulmonary bypass (mini-CPB) circuit, a closed system with neither cardiotomy suction nor an open venous reservoir and thus no air-blood interface, reportedly reduces blood loss and inflammatory reactions associated with coronary bypass surgery. We evaluated the inflammatory reactions in patients in whom coronary bypass operations were performed with conventional CPB or mini-CPB (n=15 each). Interleukin (IL)-6, IL-8, and neutrophil elastase levels; the neutrophil count; and the C-reactive protein value were measured before and immediately after surgery and on postoperative days 1 and 2. In addition, intraoperative blood loss and the transfusion volume were evaluated in these groups. Neutrophil elastase levels were lower in the mini-CPB group than in the conventional group on postoperative days 1 (127 +/- 52 vs. 240 +/- 100 microg/l, P=0.013) and 2 (107 +/- 17 vs. 170 +/- 45 micro/l, P=0.0001), as was the IL-8 level on postoperative day 1 (8.3 +/- 6.4 vs. 19 +/- 11 pg/ml, P=0.016). The intraoperative blood loss and transfusion volumes were significantly lower in the mini-CPB group than in the conventional group (510 +/- 244 vs. 1046 +/- 966 ml, P=0.012, and 691 +/- 427 vs. 1416 +/- 918 ml, P=0.0033). Thus, mini-CPB appears to attenuate neutrophil activation and cytokine release after coronary bypass surgery and, in addition, has some beneficial effects on blood conservation.

Separation of mediastinal shed blood during aortic valve surgery elicits a reduced inflammatory response

“…Although not statistically significant in our patients, there was reduced leukocytosis in the Admiral group. A similar pattern of leukocytosis was noted by Ohata et al, 18 who compared miniaturized and conventional CPB systems.…”

Neutrophil Elastase Inhibitor Sivelestat Attenuates Perioperative Inflammatory Response in Pediatric Heart Surgery With Cardiopulmonary Bypass

“…18) Moreover, some studies have shown that inflammation markers, such as CRP, leucocytes, and cytokines, are lower when mini-extracorporeal circulation is used for adults. 19,20) Miyaji, et al showed that the miniaturized circuits reduced the perioperative inflammatory response in neonates and small infants. 21) Sivelestat has been commercially available and commonly used as a treatment for acute lung injury associated with systemic inflammatory response in Japan since 2002.…”

Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery

“…It has been shown that, despite using different CPB systems, the use of Mini-CPB is associated with reduced intraoperative haemodilution,22 24 – 28 postoperative bleeding,22 24 26 18 overall need for a blood transfusion,18 26 time to extubation,10 F-shunts9 and risk of low cardiac output syndrome 27 29. Furthermore, lower postoperative creatinine levels,27 29 higher platelet counts,26 27 29 lower C-reactive protein,27 30 lower troponin T levels,28 lower CK-MB levels28 31 as well as decreased levels of IL-8,22 IL-6,25 26 32 TNF-α,16 25 IL-10,16 thromboxane B2,26 prothrombin fragment 1+2,32 plasmin–antiplasmin complex,32 von Willebrand factor levels,33 neutrophil elastase,16 22 24 25 circulating endothelial cells,33 terminal complement complex,24 N-acetyl-glucoaminidase,26 intestinal fatty acid26 and CC1610 have been observed after the use of Mini-CPB compared with C-CPB.…”

“…Furthermore, lower postoperative creatinine levels,27 29 higher platelet counts,26 27 29 lower C-reactive protein,27 30 lower troponin T levels,28 lower CK-MB levels28 31 as well as decreased levels of IL-8,22 IL-6,25 26 32 TNF-α,16 25 IL-10,16 thromboxane B2,26 prothrombin fragment 1+2,32 plasmin–antiplasmin complex,32 von Willebrand factor levels,33 neutrophil elastase,16 22 24 25 circulating endothelial cells,33 terminal complement complex,24 N-acetyl-glucoaminidase,26 intestinal fatty acid26 and CC1610 have been observed after the use of Mini-CPB compared with C-CPB. Interestingly, Mini-CPB has been associated with a decreased injury of the pulmonary alveolar capillary membrane as shown by reduced release of pneumoprotein Clara-cell 16 10…”