Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation

Fromes, Yves; Gaillard, D; Ponzio, Olivier; Chauffert, M; Gerhardt, Marie-Françoise; Deleuze, Philippe; Bical, O

doi:10.1016/s1010-7940(02)00372-x

Cited by 295 publications

(280 citation statements)

References 24 publications

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“…A substantial feature of all 'mini-CPB' systems is the lack of contact of the blood with the air due to the absence of the cardiotomy reservoir. The presence of barriers separating the blood from the air and decreasing the surface of contact of artificial materials with the blood gives measurable benefits, such as reduction in the incidence of the systemic inflammatory response syndrome (SIRS), although SIRS itself occurs almost always, with a variable degree of severity [1,2]. 'Mini-CPB' significantly decreases the incidence of early inflammatory response, which was confirmed in a randomised trial by Kiaii et al [3] and in other studies [1,4].…”

Section: Discussionmentioning

confidence: 89%

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: Commonly used cardiopulmonary bypass systems with cardiotomy reservoir, oxygenator, and roller pump require preoperative crystalloid filling. Radical reduction of the filling fluid volume and replacing it with the patient's own blood has a fundamental impact on the outcome. Aim:A comparison of cardiopulmonary bypass filled with the patient's blood, applied in Poland for the first time, and the classical system filled with crystalloids.Methods: Non-randomised trial in which patients undergoing coronary artery bypass grafting were divided into two groups: first operated on with use of cardiopulmonary bypass system with the patient's own blood priming, and a control group operated on with standard technique. Levels of haemoglobin (HGB), haematocrit (HCT), platelets, leukocytes, creatinine, protein, C-reactive protein, procalcitonin, volume of transfused blood products, postoperative drain output, time to extubation, and consumption of catecholamines were compared. Results:The results of a study comparing the classical system with the blood-filled system (n = 60) showed a significantly smaller decrease in HGB and HCT levels (p = 0.001), resulting in reduction of blood product transfusions by 75% (p = 0.03). The new type of extracorporeal circulation reduced the total postoperative drain output by approximately 28% (p = 0.003). The systemic inflammatory response syndrome (SIRS) was less pronounced and the tissue perfusion was better due to smaller degree of haemodilution leading to better organ and heart protection. The patients required shorter mechanical ventilation times in the perioperative period. Conclusions:The use of a new system of cardiopulmonary bypass filled with the patient's blood reduces the postoperative decrease in HGB and HCT, the amount of transfused blood products, and total postoperative drain output. It also shortens the time spent on mechanical ventilatory support.

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Section: Discussionmentioning

confidence: 89%

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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“…In piglet experimental models, an exhaustion of cerebral energy reservoirs was demonstrated during the course of profound hypothemic circulatory arrest at a core temperature of 18°C and rewarming (18). Release of S100 protein showed higher values in patients undergoing standard CPB than after minimal extracorporeal circulation (19). Prolonged mechanical ventilation and increased the number of bypassed coronary arteries also contributed to impaired verbal memory and deteriorated cerebral blood perfusion (16).…”

Section: Discussionmentioning

confidence: 99%

Biomarkers of cerebral injury in cardiac surgery

Yuan¹

2014

Anadolu Kardiyol Derg

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The present study aims to reveal the changing patterns of cerebral biomarkers and the underlying predictive factors as a consequence of cardiac surgery. Literature retrieval of articles on S100 and S100B of recent 20 years were made in the MEDLINE database, Highwire Press and Google search. Quantitative data of S100 and S100B along with neuron-specific enolase were carefully screened, collected and statistically analyzed. The biomarkers appeared earlier and lasted longer in the cerebrospinal fluid than in the serum. All three biomarkers exhibited a similar kinetic trend in the bloodstream, reaching a peak value at the end of cardiopulmonary bypass (CPB). In adults, serum biomarkers may recover to normal earlier than in pediatrics undergoing a cardiac surgery. The patients undergoing off-pump surgery had the minimal elevations of cerebral biomarkers comparing to all other cardiac surgeries under CPB, low core temperature and/or hypothermic circulatory arrest. In patients with pre-or postoperative neurological disorders, the biomarkers in the serum elevated even before operation and persisted longer time than those without neurological disorders. The serum concentrations of the biomarkers showed direct correlation with CPB duration and core temperature. Cardiac operations may lead to cerebral damage and blood-brain barrier changes, as a consequence of CPB and low core temperature. The cerebral biomarkers including S100, S100B and neuron-specific enolase may precisely reflect the cerebral damages in cardiac surgery. Attention has to be paid to the attenuations of cerebral damage by modifying the surgical conditions of CPB and core temperature.

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“…The heparin pre-treatment of the circuit minimizes the systemic heparinization dose requirements (usually half dose of conventional ECC: 150IU/Kg instead of 300IU/Kg) (Curtis et al 2010;Formica et al 2009, Puheler et al 2009Beghi et. 2006) and provides biocompatibility for blood cells (Koivisto et al 2010;Remadi et al 2007;Remadi et al 2004;Fromes et al 2002;) Fig. 1.…”

Section: Anatomy Of the Miniaturized Extracorporeal Circulation Systemmentioning

confidence: 99%

“…These characteristics lead to a circuit prime volume smaller than standard ECC, ranging between 200-650 ml for the MECC against 1200-1600 ml for the standard ECC (Formica et al 2009Remady et al 2006). The combination of short length tubing, heparin pre-treatment, small size tubing and absence of a venous reservoir, leads to a significant reduction of hemodilution with as well as a reduction in clotting factor consumption ad triggering of SIRS (Vohra et al 2009;Ohata et al 2007;Wippermann et al 2005;Fromes et al 2002). The blood pump included in the circuit is usually a centrifugal pump.…”

Section: Anatomy Of the Miniaturized Extracorporeal Circulation Systemmentioning

confidence: 99%

Miniaturized Extracorporeal Circulation

Formica¹,

Paolini²

2012

Front Lines of Thoracic Surgery

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Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation

Abstract: The MECC system is suitable to maintain total extracorporeal circulation and demonstrates a lower inflammatory reaction when compared to standard CPB.

Cited by 295 publications

References 24 publications

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Biomarkers of cerebral injury in cardiac surgery

Miniaturized Extracorporeal Circulation

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