The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 5 , Pages 1289-1297 , May 2011

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

  • Atsushi Nakahira, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
    • Corresponding Author InformationAddress for reprints: Atsushi Nakahira, MD, PhD, Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka 545-8585 Japan.
    • ,
  • Yasuyuki Sasaki, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
    • ,
  • Hidekazu Hirai, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
    • ,
  • Mitsunori Matsuo

      Affiliations

    • Department of Extracorporeal Circulation, Osaka City University Hospital, Osaka, Japan
    • ,
  • Akimasa Morisaki, MD

      Affiliations

    • Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
    • ,
  • Shigefumi Suehiro, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
    • ,
  • Toshihiko Shibata, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

Received 21 March 2010 ,Revised 1 July 2010 ,Accepted 13 July 2010.

References 

  1. Sakwa MP, Emery RW, Shannon FL, Altshuler JM, Mitchell D, Zwada D, et al. Coronary artery bypass grafting with a minimized cardiopulmonary bypass circuit: a prospective, randomized trial. J Thorac Cardiovasc Surg. 2009;137:481–485
  2. Liebold A, Khosravi A, Westphal B, Skrabal C, Choi YH, Stamm C, et al. Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization. J Thorac Cardiovasc Surg. 2006;131:268–276
  3. Zangrillo A, Garozzo FA, Biondi-Zoccai G, Pappalardo F, Monaco F, Crivellari M, et al. Miniaturized cardiopulmonary bypass improves short-term outcome in cardiac surgery: a meta-analysis of randomized controlled studies. J Thorac Cardiovasc Surg. 2009;139:1162–1169
  4. Mazzei V, Nasso G, Salamone G, Castorino F, Tommasini A, Anselmi A. Prospective randomized comparison of coronary bypass grafting with minimal extracorporeal circulation system (MECC) versus off-pump coronary surgery. Circulation. 2007;116:1761–1767
  5. Formica F, Broccolo F, Martino A, Sciucchetti J, Giordano V, Avalli L, et al. Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: evaluation of systemic and myocardial inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg. 2009;137:1206–1212
  6. Miyaji K, Kohira S, Miyamoto T, Nakashima K, Sato H, Ohara K, et al. Pediatric cardiac surgery without homologous blood transfusion, using a miniaturized bypass system in infants with lower body weight. J Thorac Cardiovasc Surg. 2007;134:284–289
  7. Puskas JD, Steele M. Would you like some cardiopulmonary bypass with your coronary revascularization?. Circulation. 2007;116:1756–1758
  8. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108:3006–3010
  9. Edmunds LH, Colman RW. Thrombin during cardiopulmonary bypass. Ann Thorac Surg. 2006;82:2315–2322
  10. Hammon JW. Extracorporeal circulation: the response of humoral and cellular elements of blood to extracorporeal circulation. In:  Cohn LH editors. Cardiac surgery in the adult. 3rd ed.. New York: McGraw-Hill; 2007;p. 370–389
  11. Ovrum E, Brosstad F, Am Holen E, Tangen G, Abdelnoor M. Effects on coagulation and fibrinolysis with reduced versus full systemic heparinization and heparin-coated cardiopulmonary bypass. Circulation. 1995;92:2579–2584
  12. Tanaka H, Oshiyama T, Narisawa T, Mori T, Masuda M, Kishi D, et al. Clinical study of biocompatibility between open and closed heparin-coated cardiopulmonary bypass circuits. J Artif Organs. 2003;6:245–252
  13. Schonberger JP, Everts PA, Hoffmann JJ. Systemic blood activation with open and closed venous reservoirs. Ann Thorac Surg. 1995;59:1549–1555
  14. de Somer F, van Belleghem Y, Caes F, Francois K, van Overbeke H, Arnout J, et al. Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2002;123:951–958
  15. Rubens FD, Boodhwani M, Mesana T, Wozny D, Wells G, Nathan HJ. The cardiotomy trial: a randomized, double-blind study to assess the effect of processing of shed blood during cardiopulmonary bypass on transfusion and neurocognitive function. Circulation. 2007;116(Suppl):I89–I97
  16. Djaiani G, Fedorko L, Borger MA, Green R, Carroll J, Marcon M, et al. Continuous-flow cell saver reduces cognitive decline in elderly patients after coronary bypass surgery. Circulation. 2007;116:1888–1895
  17. Chandler WL. Effects of hemodilution, blood loss, and consumption on hemostatic factor levels during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2005;19:459–467
  18. Fabre O, Vincentelli A, Corseaux D, Juthier F, Susen S, Bauters A, et al. Comparison of blood activation in the wound, active vent, and cardiopulmonary bypass circuit. Ann Thorac Surg. 2008;86:537–541
  19. Philippou H, Adami A, Davidson SJ, Pepper JR, Burman JF, Lane DA. Tissue factor is rapidly elevated in plasma collected from the pericardial cavity during cardiopulmonary bypass. Thromb Haemost. 2000;84:124–128
  20. Chung JH, Gikakis N, Rao AK, Drake TA, Colman RW, Edmunds LH. Pericardial blood activates the extrinsic coagulation pathway during clinical cardiopulmonary bypass. Circulation. 1996;93:2014–2018
  21. Burman JF, Chung HI, Lane DA, Philippou H, Adami A, Lincoln JC. Role of factor XII in thrombin generation and fibrinolysis during cardiopulmonary bypass. Lancet. 1994;344:1192–1193
  22. Gando S. Tissue factor in trauma and organ dysfunction. Semin Thromb Hemost. 2006;32:48–53
  23. Tabuchi N, de Haan J, Boonstra PW, van Oeveren W. Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1993;106:828–833
  24. Moor E, Blomback M, Silveira A, Wiman B, Cederlund K, Bergstrand L, et al. Haemostatic function in patients undergoing coronary artery bypass grafting: peroperative perturbations and relations to saphenous vein graft closure. Thromb Res. 2000;98:39–49
  25. Kauhanen P, Siren V, Carpen O, Vaheri A, Lepantalo M, Lassila R. Plasminogen activator inhibitor-1 in neointima of vein grafts: its role in reduced fibrinolytic potential and graft failure. Circulation. 1997;96:1783–1789
  26. Rifon J, Paramo JA, Panizo C, Montes R, Rocha E. The increase of plasminogen activator inhibitor activity is associated with graft occlusion in patients undergoing aorto-coronary bypass surgery. Br J Haematol. 1997;99:262–267
  27. Shann KG, Likosky DS, Murkin JM, Baker RA, Baribeau YR, DeFoe GR, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg. 2006;132:283–290
  28. Belway D, Rubens FD, Wozny D, Henley B, Nathan HJ. Are we doing everything we can to conserve blood during bypass? A national survey. Perfusion. 2005;20:237–241

 Dr Nakahira received support from the 106th Annual Congress of Japan Surgical Society Memorial Surgical Research Fund.

 Disclosures: Authors have nothing to disclose with regard to commercial support.

PII: S0022-5223(10)00745-2

doi: 10.1016/j.jtcvs.2010.07.024

The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 5 , Pages 1289-1297 , May 2011

Article Tools

* Image Usage & Resolution