Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response.

• BACKGROUND: Cardiotomy suction and autotransfusion of mediastinal shed blood may contribute to the inflammatory response after cardiac surgery. We compared inflammatory activation, myocardial injury, bleeding, and hemoglobin levels in patients undergoing coronary surgery with or without retransfusion of cardiotomy suction blood and mediastinal shed blood. METHODS: Twenty-nine patients were included in a prospective randomized study. Cardiotomy suction blood and mediastinal shed blood were either retransfused or discarded. Plasma concentrations of the cytokines tumor necrosis factor-alpha and interleukin-6 and complement factor C3a were measured preoperatively and 10 minutes, 2 hours, and 24 hours after cardiopulmonary bypass. C-reactive protein, erythrocyte sedimentation rate, troponin-T, and hemoglobin levels were analyzed preoperatively, and 24 and 48 hours after cardiopulmonary bypass. Postoperative bleeding the first 12 hours was registered. RESULTS: Baseline data did not differ between the groups. Plasma concentrations of tumor necrosis factor-alpha, interleukin-6, and C3a increased after surgery in both groups but significantly less in the group without cardiotomy suction and autotransfusion. The peak delta values in the no-retransfusion group was 36% (tumor necrosis factor-alpha), 47% (interleukin-6), and 75% (C3a) of the values in the retransfusion group. C-reactive protein, erythrocyte sedimentation rate, and troponin-T increased after surgery in both groups without intergroup differences. Postoperative bleeding and hemoglobin levels did not differ between the groups. No patient received homologous blood transfusion. CONCLUSIONS: Coronary surgery without retransfusion of cardiotomy suction blood and mediastinal shed blood reduces the postoperative systemic inflammatory response.

Nyckelord

Adult

Aged

Aged

80 and over

Biological Markers

Blood Sedimentation

Blood Transfusion

Autologous

adverse effects

methods

statistics & numerical data

C-Reactive Protein

analysis

Cardiac Surgical Procedures

Cardiopulmonary Bypass

Complement C3a

analysis

Hemoglobins

analysis

Humans

Interleukin-6

blood

Kidney Function Tests

Middle Aged

Myocardium

pathology

Postoperative Complications

epidemiology

etiology

prevention & control

Postoperative Hemorrhage

epidemiology

Prospective Studies

Respiration

Artificial

statistics & numerical data

Suction

adverse effects

statistics & numerical data

Systemic Inflammatory Response Syndrome

epidemiology

etiology

prevention & control

Troponin T

blood

Tumor Necrosis Factor-alpha

analysis

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ref (ämneskategori)

art (ämneskategori)