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J Thorac Cardiovasc Surg 2002;123:951-958
© 2002 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology (CSP) |
From the Heart Centre,a University Hospital Gent, and Centre for Molecular and Vascular Biology,b University Leuven, Belgium.
Received for publication Sept 7, 2001. Accepted for publication Sept 7, 2001. Address for reprints: G. Van Nooten, MD, PhD, University Hospital Gent, Centre for Cardiac Surgery 51E-K12, De Pintelaan 185, B-9000 Gent, Belgium (E-mail: Guido.VanNooten{at}rug.ac.be).
Objective: This study investigates the influence of foreign material and blood aspirated from nonvascular structures on activation of coagulation, hemolysis, and blood loss.
Methods: The series comprises 3 randomized groups (groups C, S, and S+P) of 10 patients undergoing routine coronary artery bypass grafting with cardiopulmonary bypass. In group C, the control group, all aspirated blood was returned into the circulation. In group S suction blood was discarded, whereas group S+P was identical to group S, with surfaces coated with phosphorylcholine. Plasma concentrations of ß-thromboglobulin, thrombin generation, haptoglobin, and free hemoglobin, as well as blood loss, were measured.
Results: A steady increase in free plasma hemoglobin, as well as an increased generation of thrombin, was noticed in group C. Moreover, a close correlation (r = 0.916) between the generation of thrombin and its inhibition (thrombin-antithrombin complexes) was observed. Platelets were clearly activated in group C and, to a lesser extent, in group S. In contrast, platelet activation in group S+P was negligible, resulting in a 30% decrease in blood loss (P = .05).
Conclusions: Aspirated blood contaminated by tissue contact is the most important activator of the coagulation system and the principal cause of hemolysis during cardiopulmonary bypass. Contact with a foreign surface is not a main variable in the procoagulant effect of bypass. Mimicking the outer cell membrane structure resulted in decreased platelet activation and decreased blood loss.
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