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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Continuous postoperative pericardial flushing reduces postoperative bleeding after coronary artery bypass grafting: A
Eva C Diephuis1, Corianne A de Borgie2, A Zwinderman2
1Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, AZ 1105, Netherlands.
Insights
Continuous postoperative pericardial flushing (CPPF) therapy significantly reduced blood loss and bleeding complications after coronary artery bypass grafting (CABG). This novel therapy shows promise for improving patient outcomes in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Surgical Hemostasis
- Postoperative Complications
Background:
- Excessive bleeding post-cardiac surgery can cause complications, often due to inadequate wound drainage and pericardial fluid accumulation.
- Continuous Postoperative Pericardial Flushing (CPPF) therapy was developed to enhance drainage and minimize blood loss.
- This study evaluates CPPF against standard care in patients undergoing coronary artery bypass grafting (CABG).
Purpose of the Study:
- To compare the efficacy of CPPF therapy versus standard care in reducing postoperative blood loss after CABG.
- To assess the impact of CPPF on bleeding-related complications, including reoperations and cardiac tamponade.
- To evaluate the cost-effectiveness of implementing CPPF therapy in cardiac surgery.
Main Methods:
- A single-center, open-label, randomized trial conducted at Amsterdam UMC.
- 169 adult patients undergoing CABG were randomized to either CPPF therapy (n=83) or standard care (n=86).
- The primary endpoint was postoperative blood loss within the first 12 hours, with secondary analysis of complications and costs.
Main Results:
- CPPF therapy demonstrated a significant reduction in postoperative blood loss (76% reduction, p≤0.001), though results were overestimated due to a measurement error.
- No patients in the CPPF group required reoperation for non-surgical bleeding, compared to 4% in the standard care group.
- Cardiac tamponade occurred in 0% of the CPPF group versus 4% in the standard care group, with an incremental cost-effectiveness ratio of €116,513.
Conclusions:
- CPPF therapy appears to reduce bleeding and associated complications following CABG.
- The therapy showed no improvement in Quality of Life (QoL), making cost considerations for implementation less relevant.
- The absence of re-interventions for bleeding or tamponade in the CPPF group supports its potential as a novel therapeutic approach.
Background:
Prolonged or excessive bleeding after cardiac surgery can lead to a broad spectrum of secondary complications. One of the underlying causes is incomplete wound drainage, with subsequent accumulation of blood and clots in the pericardium. We developed the continuous postoperative pericardial flushing (CPPF) therapy to improve wound drainage and reduce postoperative blood loss and bleeding-related complications after cardiac surgery. This study compared CPPF to standard care in patients after coronary artery bypass grafting (CABG).
Methods:
This is a single center, open label, randomized trial that enrolled patients at the Amsterdam UMC, location AMC, Amsterdam, the Netherlands. The study was registered at the 'Netherlands Trial Register', study identifier NTR5200 [1]. Adults undergoing CABG were randomly assigned to receive CPPF therapy or standard care, participants and investigators were not masked to group assignment. The primary end point was postoperative blood loss in the first 12-hours after surgery.
Findings:
Between the January 15, 2014 and the March 13, 2017, 169 patients were enrolled and assigned to CPPF therapy (study group; n = 83) or standard care (control group; n = 86). CPPF reduced postoperative blood loss when compared to standard care (median differences -385 ml, reduction 76% p=≤0.001), with the remark that these results are overestimated due to a measurement error in part of the study group. None of patients in the study group required reoperation for non-surgical bleeding versus 3 (4%, 95% CI -0.4% to 7.0%) in the control group. None of the patients in the study group suffered from cardiac tamponade, versus 3 (4%, 95% CI -0,4% to 7.0%) in the control group. The incremental cost-effectiveness ratio was €116.513 (95% bootstrap CI €-882.068 to €+897.278).
Interpretation:
The use of CPPF therapy after CABG seems to reduce bleeding and bleeding related complications. With comparable costs and no improvement in Qualty of Life (QoL), cost consideration for the implementation of CPPF is not relevant. None of the patients in the study group required re-interventions for non-surgical bleeding or acute cardiac tamponade, which underlines the proof of concept of this novel therapy.
Funding:
This study was funded by ZonMw, the Netherlands organization for health research and development (project 837001405).
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