Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system.
BACKGROUND
Transient, subclinical myocardial, renal, intestinal, and hepatic tissue injury and impaired homeostasis is detectable even in low-risk patients undergoing conventional cardiopulmonary bypass (CPB). Small extracorporeal closed circuits with low priming volumes and optimized perfusion have been developed to reduce deleterious effects of CPB.


METHODS
A prospective, randomized trial was conducted in 49 patients undergoing elective coronary artery bypass graft surgery either with the use of a standard or mini-CPB system (Synergy). We determined early postoperative inflammatory response (leukocytosis, C-reactive protein, urine interleukin-6), platelet consumption and activation (urine thromboxane B2), proximal renal tubular injury (urine N-acetyl-glucosaminidase), and intestinal injury (intestinal fatty acid binding protein).


RESULTS
In patients undergoing coronary artery bypass grafting with a mini-CPB system, we observed decreased priming volumes with subsequent attenuation of on-pump hemodilution, improved hemostatic status with reduced platelet consumption and platelet activation, decreased postoperative bleeding and minimized transfusion requirements. We also found reduced leukocytosis and decreased urinary interleukin-6. Levels of urine N-acetyl-glucosaminidase were on average threefold lower, and urinary intestinal fatty acid binding protein was 40% decreased in the patients on the mini-CPB system, as compared with standard CPB.


CONCLUSIONS
The use of the mini-CPB system during myocardial revascularization represents a viable nonpharmacologic strategy that can attenuate the alterations in the hemostatic system, reduce bleeding and transfusion requirements, decrease systemic inflammatory response, and reduce immediate postoperative renal and intestinal tissue injury.
Huybregts
Rien A J M
RA
Department of Cardiothoracic Surgery, Free University Medical Center, Amsterdam, The Netherlands.
Morariu
Aurora M
AM
Rakhorst
Gerhard
G
Spiegelenberg
Stefan R
SR
Romijn
Hans W A
HW
de Vroege
Roel
R
van Oeveren
Willem
W
D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control* / Q000652:urine; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011446:Prospective Studies
D015415:Biomarkers