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J Thorac Cardiovasc Surg 2006;131:1352-1357
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Hemodynamic effects of cardiotomy suction blood

Martin Westerberg, MD, PhD a , Jakob Gäbel, MD a , Anders Bengtsson, MD, PhD b , * , Johan Sellgren, MD, PhD c , Ola Eidem, ECCP a , Anders Jeppsson, MD, PhD a

a Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
c Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
b Departments of Anesthesia and Intensive Care, Eastern Hospital, Gothenburg, Sweden.

Received for publication August 2, 2005; revisions received November 23, 2005; accepted for publication December 12, 2005.

* Address for reprints: Anders Jeppsson, MD, PhD, Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden (Email: anders.jeppsson{at}vgregion.se).

OBJECTIVE: Cardiac surgery induces a systemic inflammatory activation, which in severe cases is associated with peripheral vasodilation and hypotension. Cardiotomy suction blood contains high levels of inflammatory mediators, but the effect of cardiotomy suction blood on the vasculture is unknown. We investigated the effect of cardiotomy suction blood on systemic vascular resistance in vivo and whether cell-saver processing of suction blood affects the vascular response.

METHODS: Twenty-five patients undergoing coronary surgery (mean age, 68 ± 2 years; 80% men) were included in a prospective randomized study. The patients were randomized to retransfusion of cell-saver processed (n = 13) or cell-saver unprocessed (n = 12) suction blood during full cardiopulmonary bypass. Mean arterial blood pressure was continuously registered during retransfusion, and systemic vascular resistance was calculated. Plasma concentrations of tumor necrosis factor {alpha}, interleukin 6, and complement factor C3a were measured in suction blood.

RESULTS: Retransfusion of cardiotomy suction blood induced a transient reduction in systemic vascular resistance in all patients. The peak reduction was significantly less pronounced in the group receiving cell-saver processed blood (–12% ± 2% vs –28% ± 3%, P = .001). There was a significant correlation between tumor necrosis factor {alpha} concentration in retransfused cardiotomy suction blood and peak reduction of systemic vascular resistance (r = 0.60, P = .002).

CONCLUSIONS: The results suggest cardiotomy suction blood is vasoactive and might influence vascular resistance and blood pressure during cardiac surgery. The observed vasodilation is proportional to the inflammatory activation of suction blood and can be reduced by processing suction blood with a cell-saving device before retransfusion.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; CS = cardiotomy suction; IL = interleukin; SVR = systemic vascular resistance; TNF = tumor necrosis factor




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