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Eur J Cardiothorac Surg 2005;28:127-132
© 2005 Elsevier Science NL

Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system

^a Department of Cardiothoracic and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07747 Jena-Lobeda, Germany
^b Heart-Center Brandenburg, Bernau, Germany
^c Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany

Received 15 September 2004; received in revised form 4 March 2005; accepted 31 March 2005.

^* Corresponding author. Tel.: +49 3641 9322933; fax: +49 3641 934802. (Email: jens.wippermann{at}med.uni-jena.de).

Objective: Closed circuit extracorporeal circulation (CCECC) has been developed to reduce deleterious effects of standard cardiopulmonary bypass (CPB). This study compares the effects of CCECC (CORx system), CPB, and off-pump coronary artery bypass grafting (OPCAB) on red blood cell damage, coagulation activation, fibrinolysis and cytokine expression. Methods: Thirty patients underwent coronary artery bypass grafting (CABG). Twenty of them were randomized into two groups: CCECC (n=10), CPB (n=10). While not randomized, OPCAB (n=10) served as a separate reference group. CCECC and CPB patients received cardioplegic arrest. Interleukin 6 (IL-6), free hemoglobin (fHb), von Willebrand factor activity (vWf), thrombin–antithrombin-III-complex (TATc), prothrombin fragment 1.2 (F 1+2) and plasmin–antiplasmin complex (PAPc) were assessed preoperatively, perioperatively and 24h postoperatively. Results: CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1± 5.7µmol/l; CPB, 16.8±11.4µmol/l; P=0.025; OPCAB, 3.4±1.1µmol/l). Perioperatively, CCECC exhibited significantly lower activation of coagulation and fibrinolysis than CPB, but did not differ from OPCAB (vWf: CCECC, 133±52%; CPB, 241±128%; P=0.052; OPCAB, 153±58%; TATc: CCECC, 4.7±0.9ng/ml; CPB, 31.1±15.8ng/ml; P<0.001; OPCAB, 2.4±0.6ng/ml; PAPc: CCECC, 214±30ng/ml; CPB, 897±367ng/ml; P<0.001; OPCAB, 253±98ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458±98ng/ml; CPB, 159±128ng/ml; P<0.001; OPCAB, 262±174ng/ml; IL-6: CCECC, 123.4±49.8pg/dl; CPB, 18.8±13.1pg/dl; P<0.001; OPCAB, 31.6±26.2pg/dl). Conclusions: CCECC for CABG is associated with a significant reduction of red blood cell damage and activation of coagulation cascades similar to OPCAB when compared with conventional CPB while a delayed fibrinolytic and inflammatory activity was observed. These findings require further investigation to verify the promising concept of CCECC.

Key Words: Extracorporeal circulation • Inflammatory response • Coagulatory response • Low-prime volume circuit

Abbreviations: BMI = body mass index • CABG = coronary arteries bypass grafting • CCECC = closed circuit extracorporeal circulation • CORx = cardiovention CORx system • CPB = standard cardiopulmonary bypass • F 1+2 = prothrombin fragment 1.2 • FFP = fresh frozen plasma • fHb = free hemoglobin • ICU = intensive care unit • IL-6 = interleukin 6 • LITA = left internal thoracic artery • LVEF = left ventricular ejection fraction • OPCAB = off-pump coronary artery bypass grafting • PAPc = plasmin–antiplasmin complex • POD 1 = postoperative day 1 • TATc = thrombin–antithrombin complex • vWF = von Willebrand factor activation • WBC = white blood cell count

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