Differential expression in markers for thrombin, platelet activation, and inflammation in cell saver versus systemic blood in patients undergoing on-pump coronary artery bypass graft surgery.
OBJECTIVE
Elimination of cardiotomy suction increases reliance on cell-saver blood-conservation techniques. Reinfusion of processed cell-saver blood (PCSB) even without using cardiotomy field suction may contribute to thrombin, cytokines, platelet activators, and hemolytic factors measured systemically.


METHODS
This study was designed as a prospective, unblinded observational study of patients undergoing first-time, nonemergent on-pump coronary artery bypass graft surgery.


METHODS
A university medical center.


METHODS
Fourteen patients were enrolled after informed consent.


METHODS
Arterial blood was sampled (1) before cardiopulmonary bypass, (2) immediately after bypass, and (3) 4 hours after bypass. PCSB, using the AutoLog (Medtronic, Inc, Minneapolis, MN), was sampled after bypass.


RESULTS
Blood and PCSB levels of prothrombin fragments 1.2, beta-thromboglobulin, interleukin-6, interleukin-8, polymorphonuclear leukocyte-elastase, neuron-specific enolase, and S-100beta were assayed by using enzyme-linked immunosorbent assay. Paired comparisons were performed by using paired t tests. Compared with postbypass blood, processed cell-saver blood (prepatient infusion) had higher levels of polymorphonuclear leukocyte-elastase, interleukin-8, neuron-specific enolase, and S-100beta (p <or= 0.05).


CONCLUSIONS
Reinfusion of PCSB directly and independently contributes to systemic elevations in interleukin-8, polymorphonuclear elastase, neuron-specific enolase, and S-100beta, augmenting and perhaps accentuating the postoperative inflammatory response. Further evaluation and improvement in cell-salvaging technology and processing techniques are warranted.
Takayama
Hiroo
H
Department of Surgery, Cardiothoracic Division, University of Washington School of Medicine, Seattle, WA 98195-3166, USA.
Soltow
Louise O
LO
Aldea
Gabriel S
GS
D015415:Biomarkers / Q000097:blood*; D001026:Coronary Artery Bypass / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006461:Hemolysis / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000601:surgery; D010446:Peptide Fragments / Q000097:blood; D010751:Phosphopyruvate Hydratase / Q000097:blood; D015539:Platelet Activation / Q000502:physiology*; D011446:Prospective Studies; D011516:Prothrombin; D013917:Thrombin / Q000378:metabolism*; D016896:Treatment Outcome; D001620:beta-Thromboglobulin / Q000378:metabolism
D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D010446:Peptide Fragments; D001620:beta-Thromboglobulin; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D019272:Leukocyte Elastase; D013917:Thrombin; D010751:Phosphopyruvate Hydratase