Separation of mediastinal shed blood during aortic valve surgery elicits a reduced inflammatory response

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J Cardiovasc Med (Hagerstown)


AIMS: 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).

CONCLUSION: 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.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Aortic Valve; Biomarkers; C-Reactive Protein; Cardiopulmonary Bypass; Cytokines; Equipment Design; Female; Heart Valve Prosthesis Implantation; Humans; Inflammation Mediators; Male; Middle Aged; Prospective Studies; Systemic Inflammatory Response Syndrome; Treatment Outcome

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