Coronary Artery Surgery: Cardiotomy Suction or Cell Salvage?

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2007 Oct 27

PMID 17961227

Citations 10

Authors

Kelvin Lau

Hetul Shah

Andrea Kelleher

Neil Moat

Affiliations

Soon will be listed here.

Abstract

Coronary artery bypass grafting (CABG) today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery.

Citing Articles

Adjunctive Hemoadsorption Therapy with CytoSorb in Patients with Septic/Vasoplegic Shock: A Best Practice Consensus Statement.

Mitzner S, Kogelmann K, Ince C, Molnar Z, Ferrer R, Nierhaus A J Clin Med. 2023; 12(23).

PMID: 38068250 PMC: 10707447. DOI: 10.3390/jcm12237199.

Turbulence in surgical suction heads as detected by MRI.

Hanekop G, Kollmeier J, Frahm J, Iwanowski I, Khabbazzadeh S, Kutschka I J Extra Corpor Technol. 2023; 55(2):70-81.

PMID: 37378439 PMC: 10304939. DOI: 10.1051/ject/2023015.

Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19.

Al-Attar N, Gaer J, Giordano V, Harris E, Kirk A, Loubani M J Cardiothorac Surg. 2023; 18(1):96.

PMID: 37005650 PMC: 10066978. DOI: 10.1186/s13019-023-02195-4.

Electrochemical Generation of Nitric Oxide for Medical Applications.

White C, Lehnert N, Meyerhoff M Electrochem Sci Adv. 2022; 2(5).

PMID: 36386004 PMC: 9642980. DOI: 10.1002/elsa.202100156.

Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry.

Hawchar F, Tomescu D, Trager K, Joskowiak D, Kogelmann K, Soukup J PLoS One. 2022; 17(10):e0274315.

PMID: 36282800 PMC: 9595535. DOI: 10.1371/journal.pone.0274315.

References

Moody D, Brown W, Challa V, Stump D, Reboussin D, Legault C . Brain microemboli associated with cardiopulmonary bypass: a histologic and magnetic resonance imaging study. Ann Thorac Surg. 1995; 59(5):1304-7. DOI: 10.1016/0003-4975(95)00057-r. View

Kincaid E, Jones T, Stump D, Brown W, Moody D, Deal D . Processing scavenged blood with a cell saver reduces cerebral lipid microembolization. Ann Thorac Surg. 2000; 70(4):1296-300. DOI: 10.1016/s0003-4975(00)01588-5. View

Rogers M, Blumberg N, Saint S, Kim C, Nallamothu B, Langa K . Allogeneic blood transfusions explain increased mortality in women after coronary artery bypass graft surgery. Am Heart J. 2006; 152(6):1028-34. DOI: 10.1016/j.ahj.2006.07.009. View

Kuduvalli M, Oo A, Newall N, Grayson A, Jackson M, Desmond M . Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2005; 27(4):592-8. DOI: 10.1016/j.ejcts.2005.01.030. View

Remadi J, Marticho P, Butoi I, Rakotoarivelo Z, Trojette F, Benamar A . Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution?. Ann Thorac Surg. 2004; 77(6):2172-5. DOI: 10.1016/S0003-4975(03)00977-9. View

Svenmarker S, Engstrom K . The inflammatory response to recycled pericardial suction blood and the influence of cell-saving. Scand Cardiovasc J. 2003; 37(3):158-64. DOI: 10.1080/14017430310001465. View

Liebold A, Khosravi A, Westphal B, Skrabal C, Choi Y, Stamm C . Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization. J Thorac Cardiovasc Surg. 2006; 131(2):268-76. DOI: 10.1016/j.jtcvs.2005.09.023. View

Reents W, Babin-Ebell J, Misoph M, Schwarzkopf A, Elert O . Influence of different autotransfusion devices on the quality of salvaged blood. Ann Thorac Surg. 1999; 68(1):58-62. DOI: 10.1016/s0003-4975(99)00472-5. View

Abu-Omar Y, Balacumaraswami L, Pigott D, Matthews P, Taggart D . Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures. J Thorac Cardiovasc Surg. 2004; 127(6):1759-65. DOI: 10.1016/j.jtcvs.2003.09.048. View

10.

Guru V, Glasgow K, Fremes S, Austin P, Teoh K, Tu J . The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system. Can J Cardiol. 2007; 23(4):281-6. PMC: 2647884. DOI: 10.1016/s0828-282x(07)70755-9. View

11.

Stover E, Siegel L, Parks R, Levin J, Body S, Maddi R . Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology. 1998; 88(2):327-33. DOI: 10.1097/00000542-199802000-00009. View

12.

Ovrum E, Tangen G, Brosstad F, Ringdal M, Oystese R . Autotransfusion in coronary artery bypass grafting: disparity in laboratory tests and clinical performance. J Thorac Cardiovasc Surg. 1999; 118(4):610-7. DOI: 10.1016/s0022-5223(99)70005-x. View

13.

Fromes Y, Gaillard D, Ponzio O, Chauffert M, Gerhardt M, Deleuze P . Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg. 2002; 22(4):527-33. DOI: 10.1016/s1010-7940(02)00372-x. View

14.

Johnell M, Elgue G, Larsson R, Larsson A, Thelin S, Siegbahn A . Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface. J Thorac Cardiovasc Surg. 2002; 124(2):321-32. DOI: 10.1067/mtc.2002.122551. View

15.

Brown W, Moody D, Challa V . Cerebral fat embolism from cardiopulmonary bypass. J Neuropathol Exp Neurol. 1999; 58(2):109-19. DOI: 10.1097/00005072-199902000-00001. View

16.

Paparella D, Galeone A, Venneri M, Coviello M, Scrascia G, Marraudino N . Activation of the coagulation system during coronary artery bypass grafting: comparison between on-pump and off-pump techniques. J Thorac Cardiovasc Surg. 2006; 131(2):290-7. DOI: 10.1016/j.jtcvs.2005.10.018. View

17.

Whitaker D, Newman S, Stygall J, Hope-Wynne C, Harrison M, Walesby R . The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2004; 25(2):267-74. DOI: 10.1016/j.ejcts.2003.11.007. View

18.

Ascione R, Lloyd C, Underwood M, Lotto A, Pitsis A, Angelini G . Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg. 2000; 69(4):1198-204. DOI: 10.1016/s0003-4975(00)01152-8. View

19.

Brooker R, Brown W, Moody D, Hammon Jr J, Reboussin D, Deal D . Cardiotomy suction: a major source of brain lipid emboli during cardiopulmonary bypass. Ann Thorac Surg. 1998; 65(6):1651-5. DOI: 10.1016/s0003-4975(98)00289-6. View

20.

Jewell A, Akowuah E, Suvarna S, Braidley P, Hopkinson D, Cooper G . A prospective randomised comparison of cardiotomy suction and cell saver for recycling shed blood during cardiac surgery. Eur J Cardiothorac Surg. 2003; 23(4):633-6. DOI: 10.1016/s1010-7940(02)00834-5. View