Cell salvage alters the systemic inflammatory response after off-pump coronary artery bypass grafting surgery.
BACKGROUND
Retransfused cardiotomy suction blood contains elevated inflammatory markers and is a bypass independent source of inflammatory mediators. We hypothesized that, during off-pump coronary artery bypass (OPCAB) grafting surgery, avoiding retransfusion of unwashed cardiotomy suction blood would beneficially alter both urinary and plasma cytokine concentrations and be renoprotective.


METHODS
Thirty-seven OPCAB surgery patients were randomly allocated to control (retransfusion of unwashed shed blood) and treatment (retransfusion of washed shed blood or discarding of unwashed blood) groups. Over 72 hours we measured plasma (tumor necrosis factor-alpha [TNF-alpha], interleukin-8, interleukin-6, interleukin-10, TNF soluble receptor-2, and interleukin-1 receptor antagonist) and urinary TNF soluble receptor-2 and interleukin-1 receptor antagonist and markers of renal injury and dysfunction (N-acetyl beta D glucosaminidase and alpha1-microglobulin).


RESULTS
We demonstrated elevated proinflammatory cytokines in cardiotomy suction blood, which were effectively eliminated by cell salvage. After retransfusion, in comparison with controls, the treatment group had reduced plasma TNF soluble receptor-2. As compared with controls, treatment group patients also demonstrated significantly reduced levels of the urinary anti-inflammatory cytokine TNF soluble receptor-2. There were no between group differences in markers of renal injury or dysfunction.


CONCLUSIONS
We have demonstrated that the management of shed mediastinal blood alters perioperative, systemic, plasma and urinary cytokine homeostasis at OPCAB surgery but does not impact on subclinical renal injury or dysfunction in this low risk group of patients.
Allen
Stephen J
SJ
Department of Clinical Anaesthesia, Royal Group of Hospitals Trust, Belfast, Ireland. stephen.allen@royalhospitals.n-i.nhs.uk
McBride
William T
WT
McMurray
Terence J
TJ
Phillips
Anne S
AS
Penugonda
S Prasad
SP
Campalani
Gianfranco
G
Young
Ian S
IS
Armstrong
Marilyn A
MA
D000368:Aged; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D047549:Coronary Artery Bypass, Off-Pump; D016207:Cytokines / Q000097:blood* / Q000652:urine*; D005260:Female; D006706:Homeostasis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood* / Q000652:urine*; D007674:Kidney Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood / Q000652:urine
D016207:Cytokines; D018836:Inflammation Mediators; D047889:Receptors, Tumor Necrosis Factor, Type II