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Separation of mediastinal shed blood during aortic valve surgery elicits a reduced inflammatory response

Bisleri, Gianluigi; Tononi, Laura; Morgan, Jeffrey A.; Bordonali, Tania; Cheema, Faisal H.; Siddiqui, Osama T.; Repossini, Alberto; Rosati, Fabrizio; Muneretto, Claudio

Journal of Cardiovascular Medicine: January 2016 - Volume 17 - Issue 1 - p 62–68
doi: 10.2459/JCM.0000000000000017
Cardiac surgery

Aims The detrimental effects of inflammation following cardiopulmonary bypass (CPB) could negatively affect the postoperative outcome in a specific subset of high-risk patients. We therefore investigated the impact of a CPB circuit (Admiral, Eurosets, Italy) that allows separation of intracavitary and mediastinal blood on the release of biochemical markers and clinical outcome when compared with a conventional circuit.

Methods Thirty patients undergoing aortic valve surgery were prospectively enrolled and assigned to Admiral group (Group 1, G1, n = 15) or conventional CPB group (Group 2, G2, n = 15). The Admiral oxygenator allows for a separate collection of mediastinal blood processed through a cell-saver before retransfusion. Clinical data and biochemical parameters were measured preoperatively, during CPB and at different time-points postoperatively.

Results Preoperative demographics, intraoperative data (as CPB and aortic cross-clamping time) and perioperative complications did not differ between groups. Inflammatory response was significantly decreased in G1, as assessed by means of D-dimer (G1 = 1332.3 ± 953.9 vs. G2 = 2791.9 ± 1740.7 ng/ml, P = 0.02), C-reactive protein (G1 = 169.1 ± 164.8 vs. G2 = 57.1 ± 39.3 mg/l, P = 0.04), interleukin-6 (G1 = 11.8 ± 12.5 vs. G2 = 26.5 ± 24.9 pg/ml, P = 0.02) and tumour necrosis factor-alpha (G1 = 29 ± 28.7 vs. G2 = 45.5 ± 23.6 pg/ml, P = 0.03).

Conclusion Although no considerable difference was detected in terms of perioperative outcomes, the Admiral oxygenator did result in a significant reduction of inflammatory markers during the early postoperative course.

aDivision of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy

bDivision of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Michigan, USA

cDivision of Cardiology, University of Brescia Medical School, Brescia, Italy

dDivision of Cardiothoracic Surgery, Columbia College of Physicians & Surgeons, New York, New York, USA

eAga Khan University Medical School, Karachi, Pakistan

Correspondence to Gianluigi Bisleri, MD, Cardiochirurgia SSVD – Spedali Civili, P.le Spedali Civili, 1, 25123 Brescia, Italy Tel: +390303996401; fax: +390303996096; e-mail: gianluigi.bisleri@gmail.com

Received 11 January, 2013

Revised 29 January, 2014

Accepted 29 January, 2014

© 2016 Italian Federation of Cardiology. All rights reserved.