Does the type of surgery effect systemic response following cardiopulmonary bypass?
BACKGROUND
Clinical studies conducted to elucidate the systemic response to cardiopulmonary bypass (CPB) did not differentiate possible effect of different types of cardiac surgical pathologies and operations on outcomes and have typically combined different procedures. We hypothesized that valve surgery induces more prominent systemic reaction compared to isolated on-pump CABG.


METHODS
Twenty-seven patients undergoing primary on-pump CABG (Group 1, n = 14) or valve surgery with or without CABG (Group 2, n = 13) were prospectively enrolled. Heparin-bonded circuits were used in all patients. Cardiotomy suction was only used in Group 2. Clinical and laboratory markers were evaluated.


RESULTS
Clinical measurements, including chest tube output, blood transfusion requirement, inotropic support requirement, and duration of ICU stay were not significantly different. Thrombin generation (PF-1.2) was significantly higher in Group 2 (p = 0.001). tPA was also significantly higher in Group 2 at 15 and 60 minutes on CPB (p < 0.01). Group 2 had significantly higher inflammatory response shown by elevation of IL6 (p = 0.005). Neuronal injury markers, S100beta and NSE, were significantly higher at the termination of CPB in Group 2 (p < 0.01). At no point of time course for any marker, Group 1 had significantly higher response compared to Group 2.


CONCLUSIONS
Valve surgery induced more prominent systemic response than CABG. The possible explanations include the difference in baseline disease pathophysiology, and/or difference associated with the procedures such as open systems and use of cardiotomy suction. Future clinical studies assessing systemic response to CPB and therapies to blunt these need consider and account for these observed differences.
Department of Surgery, Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Hiroo
H
Takayama
Louise O
LO
Soltow
Wayne L
WL
Chandler
Craig R
CR
Vocelka
Gabriel S
GS
Aldea
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015505:Chest Tubes / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D009418:S100 Proteins / Q000097:blood; D013917:Thrombin / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000378:metabolism
D002316:Cardiotonic Agents; D015850:Interleukin-6; D009418:S100 Proteins; D013917:Thrombin; D010959:Tissue Plasminogen Activator; D010751:Phosphopyruvate Hydratase