The Early Inflammatory Response in a Mini–Cardiopulmonary Bypass System a Prospective Randomized Study

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The aim of this study was to compare the early systemic inflammatory response of the Resting Heart System (RHS; Medtronic, Minneapolis, MN USA), a miniaturized cardiopulmonary bypass (CPB) system, with two groups using a standard extracorporeal circulation system during on-pump coronary artery bypass grafting (CABG) surgery. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A total of 60 consecutive patients requiring CABG were prospectively randomized to undergo on-pump CABG using conventional CPB without cardiotomy suction (group A), conventional CPB with cardiotomy suction (group B), or the RHS (group C). Blood samples were collected at five time points: immediately before CPB, 30 minutes into CPB, immediately at the end of CPB, 30 minutes post-CPB, and 1 hour post-CPB. Inflammation was analyzed by changes in (a) levels of plasma proteins, including inflammatory cytokines (interleukin-6 [IL-6], IL-10, and tumor necrosis factor-α), chemokines (IL-8, monokine induced by interferon-γ, monocyte chemotactic protein-1, regulated on activation normal T cell expressed and secreted, and interferon-inducible protein-10), and acute phase proteins (C-reactive protein and complement protein 3); (b) biochemical variables (cardiac troponin I, hematocrit, and immunoglobulin G); and (c) cell numbers (leukocytes, neutrophils, and thrombocytes). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The RHS showed more delayed secretion of the cytokines tumor necrosis factor-α and IL-10, chemokines monokine induced by interferon-γ (P &lt; 0.001); IL-8, and interferon-inducible protein-10; and complement protein 3 than conventional CPB systems did. Median thrombocyte numbers were higher in the RHS group. Levels of cardiac troponin I, monocyte chemotactic protein-1, and IL-6 were lower in both the RHS and conventional CPB without suction than with suction. Levels of C-reactive protein and regulated on activation normal T cell expressed and secreted, plus leukocyte and neutrophil numbers, were similar in all groups. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> The Medtronic RHS may induce less systemic inflammation than conventional CPB systems, particularly when cardiotomy suction was used, but it did not result in improved clinical benefit. </jats:p></jats:sec>

The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

“…Increased neutrophil margination into several tissues, particularly the lungs, has been described during ECMO, both in animal models and in neonates [14, 15, 30, 94]. Overall, neutrophil numbers increase after the initiation of extracorporeal circulation [95] and neutrophil function appears to be preserved [25, 28]. This is despite the reported adverse effects of ECMO on leukocyte rheology [96].…”

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

“…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]. In our study we found earlier rise of the CRP and procalcitonin levels as well as leukocyte count in the 'mini-CPB' group than in the control group by approximately 24 h, with a gradual decrease thereafter in both groups.…”

How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients

“…This is supported also by the study by Halonen et al [19] in which the incidence of postoperative AF was significantly lower in patients treated with intravenous metoprolol as compared to metoprolol by mouth. Evolution of the cardiopulmonary bypass has emerged new techniques such as MECC to reduce the inflammatory response follow cardiac surgery [21][22][23]. Reducing the surface area of the circuit and removing the blood-air interface potentially offers several benefits compared to CECC including reduced hemodilution, postbypass coagulopathy, and inflammatory response [28,29].…”

“…New techniques, such as miniaturized ECC (MECC), have been developed to reduce blood-air and blood-artificial material contact and, thus, inflammatory response compared to conventional ECC (CECC) [21][22][23]. In addition, an increasing number of CABG procedures are performed without any ECC (OPCAB) aiming to less surgical trauma and even less inflammatory reaction than with CECC or MECC [24,25].…”