Similarity of coagulation and inflammation despite different surgical revascularization strategies – a prospective randomized trial

Abstract

With similarity in pivot coagulation factors, a specific detrimental influence of ONCAB on common coagulation pathways was excluded. Higher perioperative concentrations of products from the coagulation cascade most likely indicate activation of pericardial blood - recirculated only in ONCAB. Furthermore, with only temporary differences in markers of inflammation, the alternatives to ONCAB altogether were without advantage at 72 hours postoperatively. In the general answer to surgical trauma, the part of modern extracorporeal circulation is possibly overestimated.The study is registered at the German Clinical Trial Registry. Registration number DRKS00007580. URL: https://drks-neu.uniklinik-freiburg.de/drks_web/ URL: http://apps.who.int/trialsearch/.

Pericardial fluids or Cardiopulmonary Bypass—Is There a Major Culprit for Changes in Coagulation and Inflammation?

“…TAT and D-dimer effect sizes and dispersions were taken from the preceding trial. 1 Their calculated sample sizes were actually lower (16 and 26, respectively) and thus, not limiting.…”

“…A recent comparison of conventional on-pump coronary bypass surgery (ONCAB), minimized extracorporeal circulation (MECC), and off-pump coronary artery bypass (OPCAB) for myocardial revascularization revealed similarity for the majority of tested markers of coagulation and inflammation intraoperatively and up to 72 hours postoperatively. 1 However, intra-and early postoperative time courses of the coagulation markers thrombin-antithrombin (TAT) complexes and D-dimers were significantly higher in ONCAB compared with MECC and OPCAB. 1 TATs are products of the coagulation cascade and D-dimers indicate fibrinolysis.…”

“…1 However, intra-and early postoperative time courses of the coagulation markers thrombin-antithrombin (TAT) complexes and D-dimers were significantly higher in ONCAB compared with MECC and OPCAB. 1 TATs are products of the coagulation cascade and D-dimers indicate fibrinolysis. They are-compared with other coagulation markers-present in blood in low concentrations with rather short half-life times, thus possibly having been the most sensitive of tested markers.…”

“…Furthermore, several investigated markers of inflammation showed higher values for ONCAB up to 24 hours post-operatively and significantly lower leukocyte counts up to 12 hours postoperatively. 1 As a potential influencing factor in that study, direct recirculation of pericardial fluids (pericardiotomy suction) was only used in ONCAB operations but separate suction and cell saving (CS) during MECC and OPCAB.…”

“…Inclusion and exclusion criteria, anesthesia, details of conventional CPB, and surgical procedure of revascularization as ONCAB remained mainly unchanged to the predecessor study and have been described elsewhere. 1 However, hydroxyethyl starch solutions were avoided. Blood volume was supplemented to the discretion of the anesthetist with balanced electrolyte solutions, gelatine, or albumin solutions.…”