A biocompatible cardiopulmonary bypass strategy to reduce hemostatic and inflammatory alterations: a randomized controlled trial.
OBJECTIVE
Cardiopulmonary bypass (CPB) systems without a venous reservoir rarely are adopted clinically. The effects of a biocompatible CPB system with a venous reservoir were evaluated on the activation of the coagulation and inflammatory systems.


METHODS
A prospective, randomized controlled trial.


METHODS
A university hospital (single center).


METHODS
Eighty-three coronary artery bypass graft (CABG) surgery patients were assigned to the Physio group (closed venous reservoir, phosphorylcholine coating, and no cardiotomy suction) or the Standard group (open, noncoated, and cardiotomy suction used).


METHODS
Blood samples were obtained at 6 different time points before, during, and after surgery. Nuclear factor-kB (NF-κB) was evaluated before surgery and 2 and 24 hours after surgery. Myocardial damage was evaluated measuring cardiac troponin I.


RESULTS
Interleukin (IL)-6 (a marker of inflammation), prothrombin fragment 1-2 (PF-1.2, a marker of thrombin generation), plasmin-antiplasmin complex (PAP, a marker of fibrinolysis), and platelet factor 4 (PF4, a marker of platelet activation) were measured. The DNA binding activity of proinflammatory transcription factor NF-κB was quantified in the isolated lymphomonocyte cells. Surgery caused changes of all plasma biomarkers. This reaction was attenuated strongly in the Physio group; PF-1.2, PAP, and PF4 all were decreased significantly. In the Physio group, a significantly lower cardiac troponin I release was observed postoperatively. After surgery, NF-κB activity was reduced in the Physio group although this difference was not statistically significant.


CONCLUSIONS
A multimodal strategy using a closed and phosphorylcholine-coated CPB circuit together with the avoidance of cardiotomy suction reduced activation of the coagulation and fibrinolytic systems intraoperatively, although these changes did not persist postoperatively. However, no difference in clinical outcome was appreciated on a larger scale.
Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy. dpaparella@cardiochir.uniba.it
Domenico
D
Paparella
Giuseppe
G
Scrascia
Crescenzia
C
Rotunno
Nicola
N
Marraudino
Pietro
P
Guida
Micaela
M
De Palo
Giovanni
G
Rubino
Giangiuseppe
G
Cappabianca
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D006487:Hemostasis; D006801:Humans; D007249:Inflammation / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016328:NF-kappa B / Q000378:metabolism; D010767:Phosphorylcholine; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood
D016328:NF-kappa B; D019210:Troponin I; D010767:Phosphorylcholine