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Eur J Cardiothorac Surg 2002;22:527-533
© 2002 Elsevier Science NL
a Department of Cardiac Surgery, Fondation Hôpital Saint Joseph, 185 rue Raymond Losserand, 75 674 Paris Cedex 14, France
b Department of Biochemistry, Fondation Hôpital Saint Joseph, 185 rue Raymond Losserand, 75 674 Paris Cedex 14, France
Received 18 September 2001; received in revised form 9 April 2002; accepted 14 June 2002.
* Corresponding author. Tel.: +33-144-123-376; fax: +33-144-123-682
e-mail: y.fromes{at}myologie.chups.jussieu.fr
Objective: Cardiopulmonary bypass (CPB) is known to cause part of the systemic inflammatory reaction after cardiac surgery that can be responsible for organ failure. A novel technique based on a minimal extracorporeal circulation (MECC®) system has been evaluated with regard to the inflammatory response in a prospective study involving patients undergoing coronary artery bypass grafting. Methods: Sixty consecutive patients were randomly assigned to either standard normothermic CPB (n=30) or the MECC system, with a reduced priming volume, no aortic venting and no venous reservoir, excluding the blood–air interface (n=30). Specific evaluation of cytokine release (IL-1ß, IL-6, TNF-
), as well as neutrophil elastase secretion and ß-thromboglobulin release from platelets and S100 protein assay were performed. Serial blood samples were taken prior to the onset, after initiation, at the end and after weaning of the CPB; further samples were collected 6 and 24 h after the end of the CPB. Results: All patients were similar with regards to pre- and intra-operative characteristics and clinical outcomes were comparable for both groups. MECC system allowed a reduced hemodilution with a mean drop of the hematocrit of 8.5 vs. 15.3% (P<0.05). Mononuclear phagocytes dropped in a more important manner under standard CPB conditions (247±151 vs. 419±168, P=0.002), but both groups demonstrated a rise in monocyte count at the end of the CBP. No significant release of IL-1ß was observed in either group. By the end of CPB, IL-6 levels were significantly lower in the MECC group (38.8±19.6 vs. 87.9±78.9, P=0.04), despite a higher monocyte count. Plasma levels of TNF- rised significantly more during standard CPB than with the MECC system (17.8±15.4 vs. 10.1±5.6, P=0.002). With MECC, the neutrophil elastase release was reduced (72.7±47.9 vs. 219.6±103.4, P=0.001). Platelet count remained at higher values with the minimal compared to standard CPB. It is noteworthy to consider that ß-thromboglobulin levels showed slightly lower platelet activation in the MECC group at all times of CPB (110.5±55.6 vs. 134.7±46.8, P=0.10). The pattern of release of S100 protein showed higher values in patients undergoing standard CPB than after MECC. Conclusions: The MECC system is suitable to maintain total extracorporeal circulation and demonstrates a lower inflammatory reaction when compared to standard CPB.
Key Words: Coronary artery bypass grafting • Extracorporeal circulation • Inflammation • Cytokines • S100 protein
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