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Autotransfusion system or integrated automatic suction device in minimized extracorporeal circulation: influence on
Hansjörg Jenni1, Julia Rheinberger, Martin Czerny
1Clinic of Cardiovascular Surgery, University Hospital, Freiburgstrasse, 3010 Bern, Switzerland.
Insights
The continuous autotransfusion system (C.A.T.S.®) may reduce coagulation and inflammatory responses during coronary artery bypass grafting (CABG) compared to the Smart suction device. This suggests C.A.T.S.® is preferable for routine CABG when significant volume replacement is not needed.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Hemostasis and Thrombosis
Background:
- Coronary artery bypass grafting (CABG) involves cardiopulmonary bypass, which can activate coagulation and inflammatory pathways.
- Minimally invasive extracorporeal circuits (MECC) aim to reduce these systemic responses.
- The method of collecting mediastinal shed blood during CABG may influence these responses.
Purpose of the Study:
- To compare the effects of the Smart suction device versus the C.A.T.S.® system on coagulation and inflammatory markers in patients undergoing primary elective CABG with MECC.
- To evaluate surrogate markers of coagulation activation and systemic inflammatory response.
Main Methods:
- Fifty-eight patients undergoing CABG with MECC were prospectively randomized to use either the Smart suction device or C.A.T.S.® for mediastinal shed blood collection.
- Coagulation markers (thrombin-antithrombin complex [TAT] and D-dimer) and inflammatory markers (Interleukin-6 [IL-6] and complement factor 3a [C3a]) were measured pre-surgery, 2 hours post-surgery, and 18 hours post-surgery.
Main Results:
- No serious adverse cardiovascular events occurred in either group.
- Serum levels of TAT and D-dimer were significantly higher 2 hours after surgery in the Smart suction group compared to the C.A.T.S.® group (p=0.040 for TAT, p=0.025 for D-dimer).
- IL-6 levels showed a trend towards being higher in the Smart suction group (p=0.072), while C3a levels did not significantly change over time between groups.
Conclusions:
- While clinical outcomes were similar, the C.A.T.S.® system was associated with less pronounced surrogate markers of coagulation and inflammation compared to the Smart suction device.
- The findings suggest that avoiding direct reinfusion of cardiotomy blood may be beneficial.
- C.A.T.S.® is recommended for routine CABG procedures, particularly when extensive volume substitution is not anticipated.
Objective:
To measure surrogate markers of coagulation activation as well as of the systemic inflammatory response in patients undergoing primary elective coronary artery bypass grafting (CABG) using either the so-called Smart suction device or a continuous autotransfusion system (C.A.T.S.®).
Methods:
Fifty-eight patients being operated with a miniaturized circuit (minimal extracorporeal circuit, MECC) were prospectively randomized to using a so-called Smart suction device or a routine continuous autotransfusion system (C.A.T.S.®) for collection of mediastinal shed blood. The coagulation response was measured by thrombin-antithrombin complex (TAT) and D-dimer. The inflammatory response was measured by Interleukin 6 (IL-6) and complement factor 3a (C3a) at three different time points, before surgery, 2h after surgery, as well as 18 h after surgery.
Results:
No serious adverse cardiovascular event was observed. Serum levels of TAT significantly differed between both groups 2h after surgery (Smart suction 16.12 ± 13.51 μg l⁻¹ vs C.A.T.S® 9.83 ± 7.81 μg l⁻¹, p = 0.040) and returned to baseline values after 18 h in both groups. Serum levels of D-dimer showed a corresponding pattern with a peak 2h after surgery (Smart suction 1115 ± 1231 ng ml⁻¹ vs C.A.T.S.® 507 ± 604 ng ml⁻¹, p = 0.025). IL-6 levels also significantly differed between both groups 2h after surgery (Smart suction 186 ± 306 pg ml⁻¹ vs C.A.T.S.® 82 ± 71 pg ml⁻¹, p = 0.072). No significant changes in serum levels of C3a over time could be observed.
Conclusions:
Despite no differences in the clinical course of patients with either Smart suction or C.A.T.S.® being observed, surrogate markers of coagulation and inflammation seem to be less pronounced in patients where cardiotomy blood is not being directly reinfused. As such, C.A.T.S.® should be preferred in routine CABG, as long as no extensive volume substitution is anticipated.
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