Cardiotomy suction, but not open venous reservoirs, activates coagulofibrinolysis in coronary artery surgery

Objectives

Closed and miniaturized cardiopulmonary bypass circuits, which eliminate cardiotomy suction and open venous reservoirs with a reduced priming volume, have been reported to be advantageous. We comparatively examined the respective contribution of cardiotomy suction and open venous reservoirs to perioperative activation in coagulofibrinolysis and inflammation systems, with identical conditions of priming volume and anticoagulation.

Methods

A total of 75 consecutive coronary artery bypass grafting procedures were performed using 1 of the following 3 cardiopulmonary bypass circuits under identical conditions of priming volumes, heparin coating, and protocols of anticoagulation and transfusion, as follows: a circuit with an open venous reservoir and cardiotomy suction (open group, n = 25), a circuit with an open venous reservoir without cardiotomy suction (nonsuction group, n = 25), or a circuit without either (closed group, n = 25). Blood samples were collected at 8 points up to the first postoperative morning.

Results

The thrombin-antithrombin III complex, fibrinogen degeneration products, D-dimer, plasmin-α2 plasmin inhibitor complex, and plasminogen activator inhibitor-1 levels were significantly greater in the open group than those in the other 2 groups (P < .0001, for all markers). The C3a and interleukin-6 levels were similar among all the groups. The incidences of perioperative transfusion and postoperative bleeding were increased and the early graft patency rate of saphenous veins was lower in the open group than those in the other 2 groups.

Conclusions

Cardiotomy suction, but not open venous reservoirs, causes perioperative coagulofibrinolysis activation, although neither affects the inflammation system. The use of cardiotomy suction needs to be examined further in association with postoperative PAI-1 elevation and early vein graft occlusion.

CTSNet classification: 23.1, 25, 28, 37

Abbreviations and Acronyms: ACT, activated clotting time, APTT, activated partial thromboplastin time, AT, antithrombin III, CABG, coronary artery bypass grafting, CPB, cardiopulmonary bypass, FDPs, fibrinogen degeneration products, IL, interleukin, OPCAB, off-pump CABG, PAI-1, plasminogen activator inhibitor-1, PIC, plasmin-α2 plasmin inhibitor complex, PRBCs, packed red blood cells, PT, prothrombin time, TAT, thrombin-antithrombin III complex