title: Cardiotomy suction, but not open venous reservoirs, activates coagulofibrinolysis in coronary artery surgery.
abstract: OBJECTIVE
  Closed and miniaturized cardiopulmonary bypass circuits, which eliminate cardiotomy suction and open venous reservoirs with a reduced priming volume, have been reported to be advantageous. We comparatively examined the respective contribution of cardiotomy suction and open venous reservoirs to perioperative activation in coagulofibrinolysis and inflammation systems, with identical conditions of priming volume and anticoagulation.
  
  
  METHODS
  A total of 75 consecutive coronary artery bypass grafting procedures were performed using 1 of the following 3 cardiopulmonary bypass circuits under identical conditions of priming volumes, heparin coating, and protocols of anticoagulation and transfusion, as follows: a circuit with an open venous reservoir and cardiotomy suction (open group, n = 25), a circuit with an open venous reservoir without cardiotomy suction (nonsuction group, n = 25), or a circuit without either (closed group, n = 25). Blood samples were collected at 8 points up to the first postoperative morning.
  
  
  RESULTS
  The thrombin-antithrombin III complex, fibrinogen degeneration products, D-dimer, plasmin-α2 plasmin inhibitor complex, and plasminogen activator inhibitor-1 levels were significantly greater in the open group than those in the other 2 groups (P < .0001, for all markers). The C3a and interleukin-6 levels were similar among all the groups. The incidences of perioperative transfusion and postoperative bleeding were increased and the early graft patency rate of saphenous veins was lower in the open group than those in the other 2 groups.
  
  
  CONCLUSIONS
  Cardiotomy suction, but not open venous reservoirs, causes perioperative coagulofibrinolysis activation, although neither affects the inflammation system. The use of cardiotomy suction needs to be examined further in association with postoperative PAI-1 elevation and early vein graft occlusion.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. osushi123@med.osaka-cu.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakahira
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirai
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsuo
authors.forename: Akimasa
authors.initials: A
authors.lastname: Morisaki
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D004867:Equipment Design; D017707:Erythrocyte Transfusion; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D013396:Suction; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D020099:Coated Materials, Biocompatible; D018836:Inflammation Mediators