title: Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system.
abstract: OBJECTIVE
  Closed circuit extracorporeal circulation (CCECC) has been developed to reduce deleterious effects of standard cardiopulmonary bypass (CPB). This study compares the effects of CCECC (CORx system), CPB, and off-pump coronary artery bypass grafting (OPCAB) on red blood cell damage, coagulation activation, fibrinolysis and cytokine expression.
  
  
  METHODS
  Thirty patients underwent coronary artery bypass grafting (CABG). Twenty of them were randomized into two groups: CCECC (n = 10), CPB (n = 10). While not randomized, OPCAB (n = 10) served as a separate reference group. CCECC and CPB patients received cardioplegic arrest. Interleukin 6 (IL-6), free hemoglobin (fHb), von Willebrand factor activity (vWf), thrombin-antithrombin-III-complex (TATc), prothrombin fragment 1.2 (F 1+2) and plasmin-antiplasmin complex (PAPc) were assessed preoperatively, perioperatively and 24 h postoperatively.
  
  
  RESULTS
  CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1+/- 5.7 micromol/l; CPB, 16.8+/-11.4 micromol/l; P = 0.025; OPCAB, 3.4+/-1.1 micromol/l). Perioperatively, CCECC exhibited significantly lower activation of coagulation and fibrinolysis than CPB, but did not differ from OPCAB (vWf: CCECC, 133+/-52%; CPB, 241+/-128%; P = 0.052; OPCAB, 153+/-58%; TATc: CCECC, 4.7+/-0.9 ng/ml; CPB, 31.1+/-15.8 ng/ml; P < 0.001; OPCAB, 2.4+/-0.6 ng/ml; PAPc: CCECC, 214+/-30 ng/ml; CPB, 897+/-367 ng/ml; P < 0.001; OPCAB, 253+/-98 ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458+/-98 ng/ml; CPB, 159+/-128 ng/ml; P < 0.001; OPCAB, 262+/-174 ng/ml; IL-6: CCECC, 123.4+/-49.8 pg/dl; CPB, 18.8+/-13.1 pg/dl; P < 0.001; OPCAB, 31.6+/-26.2 pg/dl).
  
  
  CONCLUSIONS
  CCECC for CABG is associated with a significant reduction of red blood cell damage and activation of coagulation cascades similar to OPCAB when compared with conventional CPB while a delayed fibrinolytic and inflammatory activity was observed. These findings require further investigation to verify the promising concept of CCECC.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07747 Jena-Lobeda, Germany. jens.wippermann@med.uni-jena.de
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Albes
authors.forename: Martin
authors.initials: M
authors.lastname: Hartrumpf
authors.forename: Mirko
authors.initials: M
authors.lastname: Kaluza
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Vollandt
authors.forename: Raimund
authors.initials: R
authors.lastname: Bruhin
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000210:Acute-Phase Reaction; D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D005342:Fibrinolysis; D006461:Hemolysis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation; D010976:Platelet Count; D011184:Postoperative Period
chemical_list: D018836:Inflammation Mediators; D015850:Interleukin-6