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Objective: Cardiac surgery using cardiopulmonary bypass(CPB)causes systemic inflammatory response resulting in organ failure and cerebral dysfunction. Mini- extracorporeal circulation systems including a centrifugal pump with active drainage, low prime and a cell-saving device might reduce the inflammtory response.
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Jeannette Schönebeck1, Uwe Mehrmann2, Munif Haddad3, Beate Reiter1, Bernhard Dahme4, Hermann Reichenspurner1, Christian Detter1.
1Departement of Cardiovascular surgery, University Heart Center Hamburg, Hamburg, Germany, 2Department of Psychology III, university of Hamburg, Hamburg, Germany, 3Department of Clinical Chemistry, University of Hamburg, Hamburg, Germany, 4Department of Psychology, University of Hamburg, Hamburg, Germany.
Methods: In a prospective, randomized study 120 patients underwent coronary artery bypass grafting using either mini-extracorporeal circulation(MECC-group n=60) or conventional cardiopulmonary bypass (CPB-group, n=60)since March 2004. The mean age was 67±8years in the CPB- group and 65±8 years in the MECC- group .
Blood levels of cytokines, creatinkinase, Troponin T, S100B were serially measured at different time points( preoperatively, 0,1,6,12,24,48 hours after CPB).Neuropsychological examination(grooved pegboard Test, TAP, Syndrom Kurz Test) including functional and emotional measures (Short form 36 Test and the Hospital anxiety and Depression Scale) were performed preoperatively, two days, five days and 3 months postoperatively.
Results: Baseline characteristics, number of anastomoses, CPB and cross- clamp time, ventilation time and ICU stay and mortality were comparable. There were no significant differences in cytokines. MECC- patients demonstrated significantly lower peak levels of troponin T (0.42ng/ml versus 0.85ng/ml, p<0.0001),myocardial creatinkinase (214.4U/l versus 90.2U/l p<0.01) and S100B((1.83ng/ml versus 0.37ng/ml, p<0.001). Blood loss (1473o±1969ml versus 1077±652ml, p=0.036) and hospital stay were significantly reduced in the MECC- group(7.6± 0.2days versus 8.6± 0.6 days, p=0.041).In the MECC group there is a significance in the TAP-Test (439±57 versus 534±169 p<0.5) in the early postoperative days. The grooved pegboard Test showed significant lower levels in the MECC group (157±57 versus 136±29 p<0.5) at five days postoperatively. There were no significances in the neuropsychological tests after 3 months.
Conclusions: The MECC is a safe bypass system that reduces significantly the myocardial damage and the hospital stay. Neuropsychological tests showed significant differences in the early postoperative time, but no differences could be shown in the 3 months follow up.
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