Attenuated Renal and Intestinal Injury After Use of a Mini-Cardiopulmonary Bypass System

• Published in: The Annals of thoracic surgery Vol. 83; no. 5; pp. 1760 - 1766
• Main Authors: Huybregts, Rien A.J.M., MD, Morariu, Aurora M., MD, PhD, Rakhorst, Gerhard, PhD, Spiegelenberg, Stefan R., MD, Romijn, Hans W.A., MD, de Vroege, Roel, PhD, van Oeveren, Willem, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2007; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Biomarkers - analysis; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; Cardiothoracic Surgery; Coronary Artery Bypass; Double-Blind Method; Female; Humans; Intestinal Diseases - blood; Intestinal Diseases - etiology; Intestinal Diseases - prevention & control; Intestinal Diseases - urine; Kidney Diseases - blood; Kidney Diseases - etiology; Kidney Diseases - prevention & control; Kidney Diseases - urine; Male; Medical sciences; Middle Aged; Perfusion - methods; Prospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; 25; Cardiopulmonary bypass; Treatment; Respiratory disease; Injury; Surgery; Use; Gut; Thorax; Lesion; Trauma; Kidney; System
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.02.016

Background Transient, subclinical myocardial, renal, intestinal, and hepatic tissue injury and impaired homeostasis is detectable even in low-risk patients undergoing conventional cardiopulmonary bypass (CPB). Small extracorporeal closed circuits with low priming volumes and optimized perfusion have been developed to reduce deleterious effects of CPB. Methods A prospective, randomized trial was conducted in 49 patients undergoing elective coronary artery bypass graft surgery either with the use of a standard or mini-CPB system (Synergy). We determined early postoperative inflammatory response (leukocytosis, C-reactive protein, urine interleukin-6), platelet consumption and activation (urine thromboxane B2), proximal renal tubular injury (urine N-acetyl-glucosaminidase), and intestinal injury (intestinal fatty acid binding protein). Results In patients undergoing coronary artery bypass grafting with a mini-CPB system, we observed decreased priming volumes with subsequent attenuation of on-pump hemodilution, improved hemostatic status with reduced platelet consumption and platelet activation, decreased postoperative bleeding and minimized transfusion requirements. We also found reduced leukocytosis and decreased urinary interleukin-6. Levels of urine N-acetyl-glucosaminidase were on average threefold lower, and urinary intestinal fatty acid binding protein was 40% decreased in the patients on the mini-CPB system, as compared with standard CPB. Conclusions The use of the mini-CPB system during myocardial revascularization represents a viable nonpharmacologic strategy that can attenuate the alterations in the hemostatic system, reduce bleeding and transfusion requirements, decrease systemic inflammatory response, and reduce immediate postoperative renal and intestinal tissue injury.