Cardiotomy suction, but not open venous reservoirs, activates coagulofibrinolysis in coronary artery surgery.
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.
Nakahira
Atsushi
A
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. osushi123@med.osaka-cu.ac.jp
Sasaki
Yasuyuki
Y
Hirai
Hidekazu
H
Matsuo
Mitsunori
M
Morisaki
Akimasa
A
Suehiro
Shigefumi
S
Shibata
Toshihiko
T
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
D000925:Anticoagulants; D015415:Biomarkers; D020099:Coated Materials, Biocompatible; D018836:Inflammation Mediators