Comparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery.
OBJECTIVE
One of the complications of CPB is the systemic inflammatory response syndrome (SIRS). Recent developments tend to minimize the biological impact of CPB in using miniaturized closed circuit with reduced priming volume and less blood-air interface. The benefit of these miniaturized closed circuits in terms of inflammatory response has been proved in coronary surgery. However, in open heart surgery, the CPB circuit is no more closed and the benefit of the miniaturized set-up could disappear. The aim of the study is to compare the SIRS between standard and miniaturized circuits in aortic surgery.


METHODS
Forty patients who underwent singular aortic valve replacement were randomly assigned either to a standard CPB (group A, n=20) or to a miniaturized CPB (group B, n=20). Pertinent clinical and surgical data were collected. Hematological parameters (leukocyte and neutrophil counts) and biochemical parameters (C-reactive protein, cytokine tests) were determined pre-, on and post-CPB.


RESULTS
There were an increase in leukocyte and neutrophil counts and a decline in hematocrit in both groups. In both groups, there was a raise after CPB, in C-reactive protein, IL-6, TNF-alpha, neutrophil elastase, and IL-10. However, the raises of elastase and TNF-alpha were significantly lower after the weaning of miniaturized CPB (116+/-46 ng/ml and 10+/-4 pg/ml, respectively) compared to standard CPB (265+/-120 ng/ml, P=0.01 and 18+/-7 pg/ml, P=0.03). The raise of IL-10 is also lower with miniaturized circuit (15+/-6 pg/ml) compared to standard circuit (51+/-26, P=0.004).


CONCLUSIONS
This study demonstrates in aortic surgery, the lesser inflammatory response of a miniaturized CPB compared to a standard CPB. However, there is always some inflammation after CPB and a small bio-reactive free perfusion circuit is still to be found in open heart surgery.
Bical
Olivier M
OM
Department of Cardiac Surgery, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674 Paris Cedex, France. ombical@hopital-saint-joseph.org
Fromes
Yves
Y
Gaillard
Didier
D
Fischer
Marc
M
Ponzio
Olivier
O
Deleuze
Philippe
P
Gerhardt
Marie-Françoise
MF
Trivin
François
F
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000097:blood; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D010196:Pancreatic Elastase