Separation of mediastinal shed blood during aortic valve surgery elicits a reduced inflammatory response
Bisleri G, Tononi L, Morgan JA, Bordonali T, Cheema FH, Siddiqui OT, Repossini A, Rosati F, and Muneretto C. Separation of mediastinal shed blood during aortic valve surgery elicits a reduced inflammatory response. J Cardiovasc Med (Hagerstown) 2016; 17(1):62-68.
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