title: Separation of mediastinal shed blood during aortic valve surgery elicits a reduced inflammatory response.
abstract: OBJECTIVE
  The detrimental effects of inflammation following cardiopulmonary bypass (CPB) could negatively affect the postoperative outcome in a specific subset of high-risk patients. We therefore investigated the impact of a CPB circuit (Admiral, Eurosets, Italy) that allows separation of intracavitary and mediastinal blood on the release of biochemical markers and clinical outcome when compared with a conventional circuit.
  
  
  METHODS
  Thirty patients undergoing aortic valve surgery were prospectively enrolled and assigned to Admiral group (Group 1, G1, n = 15) or conventional CPB group (Group 2, G2, n = 15). The Admiral oxygenator allows for a separate collection of mediastinal blood processed through a cell-saver before retransfusion. Clinical data and biochemical parameters were measured preoperatively, during CPB and at different time-points postoperatively.
  
  
  RESULTS
  Preoperative demographics, intraoperative data (as CPB and aortic cross-clamping time) and perioperative complications did not differ between groups. Inflammatory response was significantly decreased in G1, as assessed by means of D-dimer (G1 = 1332.3  ±  953.9 vs. G2 = 2791.9  ±  1740.7  ng/ml, P = 0.02), C-reactive protein (G1 = 169.1  ±  164.8 vs. G2 = 57.1  ±  39.3  mg/l, P = 0.04), interleukin-6 (G1 = 11.8  ± 12.5 vs. G2 = 26.5  ±  24.9  pg/ml, P = 0.02) and tumour necrosis factor-alpha (G1 = 29  ±  28.7 vs. G2 = 45.5  ±  23.6 pg/ml, P = 0.03).
  
  
  CONCLUSIONS
  Although no considerable difference was detected in terms of perioperative outcomes, the Admiral oxygenator did result in a significant reduction of inflammatory markers during the early postoperative course.
authors.affiliation: aDivision of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy bDivision of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Michigan, USA cDivision of Cardiology, University of Brescia Medical School, Brescia, Italy dDivision of Cardiothoracic Surgery, Columbia College of Physicians & Surgeons, New York, New York, USA eAga Khan University Medical School, Karachi, Pakistan.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bisleri
authors.forename: Laura
authors.initials: L
authors.lastname: Tononi
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Tania
authors.initials: T
authors.lastname: Bordonali
authors.forename: Faisal H
authors.initials: FH
authors.lastname: Cheema
authors.forename: Osama T
authors.initials: OT
authors.lastname: Siddiqui
authors.forename: Alberto
authors.initials: A
authors.lastname: Repossini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Rosati
authors.forename: Claudio
authors.initials: C
authors.lastname: Muneretto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016207:Cytokines / Q000097:blood; D004867:Equipment Design; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D002097:C-Reactive Protein