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Updated: Jul 17, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Cell salvage alters the systemic inflammatory response after off-pump coronary artery bypass grafting surgery
Stephen J Allen1, William T McBride, Terence J McMurray
1Department of Clinical Anaesthesia, Royal Group of Hospitals Trust, Belfast, Ireland. stephen.allen@royalhospitals.n-i.nhs.uk
Insights
Managing shed mediastinal blood during off-pump coronary artery bypass (OPCAB) surgery alters cytokine levels. Avoiding retransfusion of unwashed cardiotomy suction blood reduces inflammatory markers but does not prevent subclinical renal injury.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Nephrology
Background:
- Cardiotomy suction blood contains elevated inflammatory markers.
- This blood is a bypass-independent source of inflammatory mediators.
- Unwashed cardiotomy suction blood retransfusion may contribute to perioperative inflammation.
Purpose of the Study:
- To investigate the effect of managing shed mediastinal blood on cytokine concentrations during OPCAB surgery.
- To determine if avoiding retransfusion of unwashed cardiotomy suction blood is renoprotective.
Main Methods:
- Thirty-seven OPCAB patients were randomized into control (unwashed blood retransfusion) and treatment (washed or discarded blood) groups.
- Plasma and urinary cytokine concentrations (TNF-alpha, IL-8, IL-6, IL-10, TNF soluble receptor-2, IL-1 receptor antagonist) were measured over 72 hours.
- Renal injury and dysfunction markers (NAG, alpha1-microglobulin) were assessed.
Main Results:
- Elevated proinflammatory cytokines in cardiotomy suction blood were eliminated by cell salvage.
- The treatment group showed reduced plasma TNF soluble receptor-2 compared to controls.
- Significantly reduced urinary TNF soluble receptor-2 was observed in the treatment group, but no differences in renal injury markers were found.
Conclusions:
- Management of shed mediastinal blood alters perioperative cytokine homeostasis during OPCAB surgery.
- Altering shed blood management impacts systemic, plasma, and urinary cytokine profiles.
- This intervention did not impact subclinical renal injury or dysfunction in this low-risk patient group.
Background:
Retransfused cardiotomy suction blood contains elevated inflammatory markers and is a bypass independent source of inflammatory mediators. We hypothesized that, during off-pump coronary artery bypass (OPCAB) grafting surgery, avoiding retransfusion of unwashed cardiotomy suction blood would beneficially alter both urinary and plasma cytokine concentrations and be renoprotective.
Methods:
Thirty-seven OPCAB surgery patients were randomly allocated to control (retransfusion of unwashed shed blood) and treatment (retransfusion of washed shed blood or discarding of unwashed blood) groups. Over 72 hours we measured plasma (tumor necrosis factor-alpha [TNF-alpha], interleukin-8, interleukin-6, interleukin-10, TNF soluble receptor-2, and interleukin-1 receptor antagonist) and urinary TNF soluble receptor-2 and interleukin-1 receptor antagonist and markers of renal injury and dysfunction (N-acetyl beta D glucosaminidase and alpha1-microglobulin).
Results:
We demonstrated elevated proinflammatory cytokines in cardiotomy suction blood, which were effectively eliminated by cell salvage. After retransfusion, in comparison with controls, the treatment group had reduced plasma TNF soluble receptor-2. As compared with controls, treatment group patients also demonstrated significantly reduced levels of the urinary anti-inflammatory cytokine TNF soluble receptor-2. There were no between group differences in markers of renal injury or dysfunction.
Conclusions:
We have demonstrated that the management of shed mediastinal blood alters perioperative, systemic, plasma and urinary cytokine homeostasis at OPCAB surgery but does not impact on subclinical renal injury or dysfunction in this low risk group of patients.
