Atsushi Nakahira, Yasuyuki Sasaki, Hidekazu Hirai, Toshihiro Fukui, Yosuke Takahashi, Shinsuke Kotani, Masanori Sakaguchi, Manabu Motoki, Shigefumi Suehiro.
Osaka City University Graduate School of Medicine, Osaka, Japan.
OBJECTIVE: In cardiac surgery under cardiopulmonary bypass (CPB), perioperative coagulofibrinolytic and inflammatory activations occur and can cause postoperative morbidities. A closed CPB system is a fundamental evolution in minimally invasive CPB. We evaluated whether an avoidance of the blood-to-air interface using the closed CPB contributed to the less invasive CPB.
METHODS: Since August 2006, 20 patients undergoing isolated CABG were randomly assigned to either closed CPB with Medtronic Resting Heart system (R group, n=10) or conventional CPB (C group, n=10). Except for the avoidance of blood-to-air interface, all were set to be similar in both groups, including the priming volume. Blood samples were perioperatively taken at 8 points from before the operation until the next day, to examine fibrinogen, thrombin anti-thrombin complex (TAT), fibrinogen degradation products (FDP) and D-dimer for coagulofibrinolytic activities, and complements and interleukins for inflammatory responses. Perioperative clinical data was also evaluated.
RESULTS: All patients have survived without complications. There were no significant differences in such operative parameters as the number of distal anastomoses (3.6±0.8 vs. 3.8±0.8 in R and C groups, respectively) and CPB time (154±31 vs. 165±39 minutes). The peak TAT (23.5±7.1 vs. 143±63 ng/ml, p<0.005), FDP (2.53±1.74 vs. 22.4±22μg/ml,p<0.005), D-dimer (0.94±0.49 vs. 12.9±10.7μg/ml, p<0.005, shown in Figure), C4a (1143±387 vs. 2338±1237 ng/ml, p<0.005) and IL-8 (325±137 vs. 1212±604 pg/ml, p<0.005) were significantly suppressed in R group. The postoperative peak LDH were significantly lower in R group (547±111 vs. 719±131 IU/L, p<0.05). Furthermore, R group showed reduced chest tube drainage during 24 hours postoperatively (385±103 vs. 513±221 ml, p<0.05).
CONCLUSIONS: Avoidance of blood-to-air interface in the closed CPB suppressed coagulofibrinolytic and inflammatory activations by itself. CABG with RHS may be less invasive with such clinical benefits as reduced postoperative bleeding. 
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