title: The early inflammatory response in a mini-cardiopulmonary bypass system: a prospective randomized study.
abstract: OBJECTIVE
  The aim of this study was to compare the early systemic inflammatory response of the Resting Heart System (RHS; Medtronic, Minneapolis, MN USA), a miniaturized cardiopulmonary bypass (CPB) system, with two groups using a standard extracorporeal circulation system during on-pump coronary artery bypass grafting (CABG) surgery.
  
  
  METHODS
  A total of 60 consecutive patients requiring CABG were prospectively randomized to undergo on-pump CABG using conventional CPB without cardiotomy suction (group A), conventional CPB with cardiotomy suction (group B), or the RHS (group C). Blood samples were collected at five time points: immediately before CPB, 30 minutes into CPB, immediately at the end of CPB, 30 minutes post-CPB, and 1 hour post-CPB. Inflammation was analyzed by changes in (a) levels of plasma proteins, including inflammatory cytokines (interleukin-6 [IL-6], IL-10, and tumor necrosis factor-α), chemokines (IL-8, monokine induced by interferon-γ, monocyte chemotactic protein-1, regulated on activation normal T cell expressed and secreted, and interferon-inducible protein-10), and acute phase proteins (C-reactive protein and complement protein 3); (b) biochemical variables (cardiac troponin I, hematocrit, and immunoglobulin G); and (c) cell numbers (leukocytes, neutrophils, and thrombocytes).
  
  
  RESULTS
  The RHS showed more delayed secretion of the cytokines tumor necrosis factor-α and IL-10, chemokines monokine induced by interferon-γ (P < 0.001); IL-8, and interferon-inducible protein-10; and complement protein 3 than conventional CPB systems did. Median thrombocyte numbers were higher in the RHS group. Levels of cardiac troponin I, monocyte chemotactic protein-1, and IL-6 were lower in both the RHS and conventional CPB without suction than with suction. Levels of C-reactive protein and regulated on activation normal T cell expressed and secreted, plus leukocyte and neutrophil numbers, were similar in all groups.
  
  
  CONCLUSIONS
  The Medtronic RHS may induce less systemic inflammation than conventional CPB systems, particularly when cardiotomy suction was used, but it did not result in improved clinical benefit.
authors.affiliation: Department of Surgery, University of Western Ontario, London Health Sciences Centre, University Hospital, Ivey Cardiac Centre, London, Ontario, Canada. bob.kiaii@lhsc.on.ca
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fox
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Swinamer
authors.forename: Reiza
authors.initials: R
authors.lastname: Rayman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Higgins
authors.forename: Andrew
authors.initials: A
authors.lastname: Cleland
authors.forename: Philip
authors.initials: P
authors.lastname: Fernandes
authors.forename: James
authors.initials: J
authors.lastname: MacDonald
authors.forename: Wojciech B
authors.initials: WB
authors.lastname: Dobkowski
authors.forename: Larry W
authors.initials: LW
authors.lastname: Stitt
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.forename: Bhagirath
authors.initials: B
authors.lastname: Singh
authors.forename: Yves
authors.initials: Y
authors.lastname: Bureau
authors.forename: Kelly
authors.initials: K
authors.lastname: Summers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D016207:Cytokines / Q000097:blood; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies
chemical_list: D016207:Cytokines