Abstract P77: Reduced Inflammatory Response with a Novel Cardiopulmonary Bypass Circuit: A Prospective Randomized Evaluation

Abstract

BACKGROUND: The detrimental effects of inflammation following cardiopulmonary bypass (CPB) result in poor postoperative outcomes in patients undergoing heart surgery. A novel CPB circuit (Admiral, Eurosets, Italy) with its inner surface coated with a proprietary phosphorylcholine coating was hypothesized to elicit a reduced inflammatory response compared to a conventional CPB circuit. METHODS: Patients undergoing isolated aortic valve surgery were enrolled in a prospective study and either assigned to Admiral group (Admiral, n=15) or the conventional CPB group (Dideco, n=15). The Admiral oxygenator reduces priming volumes, decreases membrane surface area and incorporates a cell-saver selectively filtering the blood collected through mediastinal cavity before re-transfusion into the patient. The conventional CPB circuit used was a Dideco D903 Avant with an open cardiotomy reservoir. Clinical data and biochemical parameters were measured postoperatively, during CPB and at 1, 18, 36, 48 and 72 hours, respectively. RESULTS: Preoperative demographics such as age (68.2±10.4 vs. 70.9±10), Euroscore (6.8±2.3 vs. 6.2±1.1) as well as others did not differ between Admiral and Dideco groups, respectively. The CPB time (Admiral=104±30 vs. Dideco=99±17 minutes, p=NS), aortic cross clamp time (Admiral=73.2±17.5 vs. Dideco=73.8±19 minutes, p=NS) and the incidence of perioperative complications were also comparable. There was a significant decrease in the Admiral group with respect to inflammatory response, assessed by means of D-dimer (Admiral=1332.3±953.9 vs. Dideco=2791.9±1740.7, p=0.02), CRP (Admiral=169.1±164.8 vs. Dideco=57.1±39.3, p=0.04), IL-6 (Admiral=11.8±12.5 vs. Dideco=26.5±24.9, p=0.02) and TNF-a (Admiral=29±28.7 vs. Dideco=45.5±23.6, p=0.03). CONCLUSIONS: Although no considerable difference was detected in terms of peri-operative outcomes, the Admiral oxygenator did result in a significant reduction of inflammatory markers in immediately postoperative course primarily due to its enhanced biocompatibility. More powerful studies may yield potentially incremental benefits with Admiral oxygenator in future.