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Role of autogenous tissue factors in hemolysis during cardiopulmonary bypass operations
E G Ford1, A L Picone, C E Baisden
1Department of Surgery, Keesler Medical Center, Keesler Air Force Base, Mississippi.
Insights
Pericardial fluid minimally contributes to hemolysis during cardiopulmonary bypass. However, pleura and skeletal muscle significantly increase free hemoglobin, highlighting the importance of minimizing tissue trauma during surgery.
Area of Science:
- Cardiovascular Surgery
- Hemolysis Research
- Biomedical Engineering
Background:
- Hemolysis is a complication during cardiopulmonary bypass (CPB).
- Pericardial fluid's role in CPB-induced hemolysis is debated.
- Understanding factors contributing to hemolysis is crucial for patient outcomes.
Purpose of the Study:
- To investigate the hemolytic potential of various tissues and fluids encountered during coronary artery bypass grafting (CABG).
- To quantify the contribution of pericardial fluid, pericardium, pleura, vein, skeletal muscle, and fat to serum free hemoglobin levels.
Main Methods:
- Blood samples from 10 patients undergoing CABG were incubated with autogenous tissues and pericardial fluid.
- Plasma was separated via centrifugation and assayed for serum free hemoglobin.
- Statistical analysis used the Bonferroni technique for multiple comparisons.
Main Results:
- Pericardial fluid showed the least hemolysis (20.7 mg/dL).
- Pleura (56.3 mg/dL) and skeletal muscle (112.3 mg/dL) significantly increased serum free hemoglobin (p < 0.05).
- Pericardium, vein, and fat did not cause significant hemolysis.
Conclusions:
- Minimizing tissue trauma and avoiding pericardial fluid aspiration are key to reducing post-bypass hemolysis.
- Pleura and skeletal muscle are significant contributors to hemolysis during CPB.
- Careful surgical technique is essential for managing hemolysis in cardiac surgery.
Abstract:
Pericardial fluid has been implicated as a causative factor in hemolysis during cardiopulmonary bypass operations. Preoperative blood samples were obtained from 10 patients undergoing coronary artery bypass grafting for ischemic myocardial disease. Whole blood samples were separately incubated with autogenous pericardial fluid, pericardium, pleura, vein, skeletal muscle, and fat harvested during the operative intervention. The plasma fraction was separated by centrifugation and assayed for serum free hemoglobin. Statistical analysis was accomplished by the Bonferroni technique to adjust for multiple comparisons. Pericardial fluid-induced hemolysis was least (20.7 mg/dL). Pleura and muscle contributed significantly to the serum free hemoglobin level (56.3 and 112.3 mg/dL, respectively; p < 0.05). Pericardium, vein, and fat did not cause significant elevations of the serum free hemoglobin level. Postbypass hemolysis is an important management consideration that may be minimized by delicate tissue manipulation and attention to minimizing tissue trauma. Avoidance of aspiration of pericardial fluid into the autotransfusion system is not supported.