Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Предупреждение системного воспалительного ответа при хирургической коррекции клапанных пороков сердца

Abstract

Objective. The aim of the study is to show that using of mechanical system for blood reinfusion with washing of red blood cells may contribute to limitation of triggers for systemic inflammation into systemic flow, thereby preventing its development and the degree of associated complications. Material and methods. The study included 100 patients with acquired valvular defects undergoing surgical correction under cardiopulmonary bypass. Prospective randomization using even and odd numbers was performed. Group I included 50 patients undergoing standard volume of intraoperative therapy (blood sampling from operative wound was performed at all stages into cardiotomy reservoir used in cardiopulmonary bypass). Group II included 50 patients in which the sampled blood from the operative wound entered into systemic flow only after preconditioning in Cell Saver apparatus. Clinical and biochemical rates, parameters of central hemodynamics, dynamics of marker concentration for systemic inflammation were studied. Results. The group, in which the method of mechanical system for blood reinfusion was used, clinical implication for the system inflammatory response was noted more than two times less often. In the main group, increase of concentration of high sensitivity C-reactive protein (hsCRP) soluble trigger receptor, expressed on myeloid cells-1 (sTREM-1), interleukins IL-6 and IL-10 after the procedure had a marked character, and the level of tumor necrosis factor (TNF) decreased. The group, in which the method of mechanical system for blood reinfusion was used, better clinical implications were noted in comparison with the group with the standard volume of intraoperative therapy. Conclusion. The use of the method of mechanical system for blood reinfusion was used during the surgical correction for acquired acquired valvular defects under cardiopulmonary bypass due to elimination of starting factors that allow restricting system inflammatory response and improving the course of postoperative period. At that, the frequency of multiple organ failure is decreasing, need for sympathomimetic and respiratory support are decreasing, the length of patients stay is decreasing, less need in extracorporeal clearance techniques.

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