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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.
Eur J Cardiothorac Surg. 2005 Jul; 28(1):127-32.EJ

Abstract

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 24 h postoperatively.

RESULTS

CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1+/- 5.7 micromol/l; CPB, 16.8+/-11.4 micromol/l; P = 0.025; OPCAB, 3.4+/-1.1 micromol/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+/-0.9 ng/ml; CPB, 31.1+/-15.8 ng/ml; P < 0.001; OPCAB, 2.4+/-0.6 ng/ml; PAPc: CCECC, 214+/-30 ng/ml; CPB, 897+/-367 ng/ml; P < 0.001; OPCAB, 253+/-98 ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458+/-98 ng/ml; CPB, 159+/-128 ng/ml; P < 0.001; OPCAB, 262+/-174 ng/ml; IL-6: CCECC, 123.4+/-49.8 pg/dl; CPB, 18.8+/-13.1 pg/dl; P < 0.001; OPCAB, 31.6+/-26.2 pg/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.

Authors+Show Affiliations

Department of Cardiothoracic and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07747 Jena-Lobeda, Germany. jens.wippermann@med.uni-jena.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15939621

Citation

Wippermann, Jens, et al. "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." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 28, no. 1, 2005, pp. 127-32.
Wippermann J, Albes JM, Hartrumpf M, et al. 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. Eur J Cardiothorac Surg. 2005;28(1):127-32.
Wippermann, J., Albes, J. M., Hartrumpf, M., Kaluza, M., Vollandt, R., Bruhin, R., & Wahlers, T. (2005). 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. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 28(1), 127-32.
Wippermann J, et al. 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. Eur J Cardiothorac Surg. 2005;28(1):127-32. PubMed PMID: 15939621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Wippermann,Jens, AU - Albes,Johannes M, AU - Hartrumpf,Martin, AU - Kaluza,Mirko, AU - Vollandt,Rüdiger, AU - Bruhin,Raimund, AU - Wahlers,Thorsten, PY - 2004/09/15/received PY - 2005/03/04/revised PY - 2005/03/31/accepted PY - 2005/6/9/pubmed PY - 2005/10/18/medline PY - 2005/6/9/entrez SP - 127 EP - 32 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 28 IS - 1 N2 - 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 24 h postoperatively. RESULTS: CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1+/- 5.7 micromol/l; CPB, 16.8+/-11.4 micromol/l; P = 0.025; OPCAB, 3.4+/-1.1 micromol/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+/-0.9 ng/ml; CPB, 31.1+/-15.8 ng/ml; P < 0.001; OPCAB, 2.4+/-0.6 ng/ml; PAPc: CCECC, 214+/-30 ng/ml; CPB, 897+/-367 ng/ml; P < 0.001; OPCAB, 253+/-98 ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458+/-98 ng/ml; CPB, 159+/-128 ng/ml; P < 0.001; OPCAB, 262+/-174 ng/ml; IL-6: CCECC, 123.4+/-49.8 pg/dl; CPB, 18.8+/-13.1 pg/dl; P < 0.001; OPCAB, 31.6+/-26.2 pg/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. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/15939621/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_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2005.03.032 DB - PRIME DP - Unbound Medicine ER -