Pericardial fluids or Cardiopulmonary Bypass-Is There a Major Culprit for Changes in Coagulation and Inflammation?

BACKGROUND:  From the results of a previous study, it remained to be investigated if a perioperative rise of few tested coagulation and inflammation markers is caused by conventional cardiopulmonary bypass (CPB) itself or rather by direct recirculation of pericardial fluids.

METHODS:  Forty-eight patients operated on with conventional CPB for myocardial revascularization were randomized either for direct recirculation of pericardial suction fluids or for cell saving (CS).

RESULTS:  Thrombin-antithrombin complexes showed lower values intraoperatively in the CS group ( p  < 0.0001), and D-dimers tended to remain lower at intensive care unit arrival ( p  = 0.095). Tests of inflammation markers were less meaningful.

CONCLUSION:  Direct recirculation of pericardial fluids rather than conventional CPB itself causes major intraoperative changes of some coagulation markers. Pericardial blood loss with direct recirculation should be kept to a minimum to avoid unnecessary activation of coagulation. Inflammation markers need further investigations.