Pericardial Fluids or Cardiopulmonary Bypass: Is There a Major Culprit for Changes in Coagulation and Inflammation?

Background: Cardiac operations on conventional cardiopulmonary bypass (CPB) are regularly followed by a rise of coagulation and inflammation markers. Whether this is caused by CPB itself or rather by direct recirculation of pericardial fluids is still under debate.

Methods: 48 CABG patients operated on with conventional CPB were prospectively randomized either for recirculation or for cell saving of pericardial suction fluids. Markers of coagulation and inflammation were measured before operation and at 4 time points intraoperatively and up to 24 hours postoperatively.

Results: Thrombin-antithrombin-complexes (TAT, half life time 5 minute) showed lower values intraoperatively (5.8 µg/L [5.4–7.3] vs. 22.2 µg/L [11.3–38.4]) and at ICU arrival (14.9 µg/L [10.8–19.0] vs. 27.6 µg/L [22.7–50.7]) in the cell saving group (p < 0.0001). D-dimers (half life time > 5 hour) tended to remain lower in the cell saving group intraoperatively and up to 6-hour post-op (p < 0.14). Other markers (leukocytes p = 0.47, intercellular adhesion molecule 1 p = 0.61, tumor necrosis factor α p = 0.20) were comparable between groups and increased during the tested time interval.

Conclusion: Recirculation of pericardial shed blood had only short term influence on coagulation markers in this study on low risk patients. Since TAT is a concisely reacting marker, it probably best reflects the effect of recirculated pericardial fluids. The operation on conventional CPB still remains a culprit for changes in coagulation and inflammation.

No conflict of interest has been declared by the author(s).