Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response.
BACKGROUND
Cardiotomy suction and autotransfusion of mediastinal shed blood may contribute to the inflammatory response after cardiac surgery. We compared inflammatory activation, myocardial injury, bleeding, and hemoglobin levels in patients undergoing coronary surgery with or without retransfusion of cardiotomy suction blood and mediastinal shed blood.


METHODS
Twenty-nine patients were included in a prospective randomized study. Cardiotomy suction blood and mediastinal shed blood were either retransfused or discarded. Plasma concentrations of the cytokines tumor necrosis factor-alpha and interleukin-6 and complement factor C3a were measured preoperatively and 10 minutes, 2 hours, and 24 hours after cardiopulmonary bypass. C-reactive protein, erythrocyte sedimentation rate, troponin-T, and hemoglobin levels were analyzed preoperatively, and 24 and 48 hours after cardiopulmonary bypass. Postoperative bleeding the first 12 hours was registered.


RESULTS
Baseline data did not differ between the groups. Plasma concentrations of tumor necrosis factor-alpha, interleukin-6, and C3a increased after surgery in both groups but significantly less in the group without cardiotomy suction and autotransfusion. The peak delta values in the no-retransfusion group was 36% (tumor necrosis factor-alpha), 47% (interleukin-6), and 75% (C3a) of the values in the retransfusion group. C-reactive protein, erythrocyte sedimentation rate, and troponin-T increased after surgery in both groups without intergroup differences. Postoperative bleeding and hemoglobin levels did not differ between the groups. No patient received homologous blood transfusion.


CONCLUSIONS
Coronary surgery without retransfusion of cardiotomy suction blood and mediastinal shed blood reduces the postoperative systemic inflammatory response.
Westerberg
Martin
M
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Bengtsson
Anders
A
Jeppsson
Anders
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001799:Blood Sedimentation; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D015926:Complement C3a / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007677:Kidney Function Tests; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013396:Suction / Q000009:adverse effects / Q000706:statistics & numerical data*; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D020107:Troponin T / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D006454:Hemoglobins; D015850:Interleukin-6; D020107:Troponin T; D014409:Tumor Necrosis Factor-alpha; D015926:Complement C3a; D002097:C-Reactive Protein