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TY - THES AU - Metzelder, Sebastian TI - Einfluss dreier verschiedener Techniken der extrakorporalen Zirkulation auf Parameter der Hämodynamik, Inflammation, Blutgerinnung und Hämolyse bei aortokoronaren Bypass-Operationen : die konventionelle Herz-Lungen-Maschine im Vergleich mit zwei miniaturisierten Bypass-Systemen CY - Aachen PB - Publikationsserver der RWTH Aachen University M1 - RWTH-CONV-113430 SP - 91 S. : Ill., graph. Darst. PY - 2009 N1 - Aachen, Techn. Hochsch., Diss., 2009 AB - The use of cardiopulmonary bypass circuits (CPB) in cardiac surgery may be associated with several adverse effects, e.g. systemic inflammatory response syndrome, hemolysis, hemodilution, coagulopathy, global hemodynamic dysfunction. These adverse effects occur due to the contact of blood with non-endothelial surfaces and air, intraoperative hypothermia, hemodilution as the result of bypass priming and traumatization of blood cells by the different blood pumps. We hypothesized that by reducing foreign surface area and extracorporeal volume, the use of miniaturized bypass systems and the avoidance of intraoperative hypothermia could reduce the adverse effects. In this prospective, randomized controlled trial, we therefore compared the use of two different simplified bypass systems (SBS) in patients undergoing normothermic on-pump beating heart coronary artery bypass grafting (CABG) with the use of a conventional CPB (cCPB) circuit in patients undergoing CABG with hypothermic cardioplegic arrest. The goal of the study was to study the influences of the three different bypass circuits on global hemodynamics and parameters of inflammation, coagulation and hemolysis and on clinical outcome parameters. The patients were randomly assigned to three groups: 15 patients were operated with a cCPB circuit in moderate hypothermia. Cardiac arrest was induced by cold crystalloid cardioplegic solution. Two groups of 15 patients each underwent beating heart surgery in normothermia with assistance of two different SBS, both with a reduction of the extracorporeal priming volume, and one with an additional reduction of the foreign surface area. Hemodynamic variables were assessed with transpulmonary thermodilution. Plasma levels of pro-inflammatory and anti-inflammatory mediators and parameters of coagulation and hemolysis were measured perioperatively. Neither the isolated reduction of the extracorporeal priming volume nor the additional reduction of the foreign surface area in SBS had beneficial effects on global hemodynamics. Moreover, the use of SBS could not reduce the systemic inflammatory response. In contrast, only patients in the cCPB-group showed a significant increase of plasma levels of anti-inflammatory mediators (interleukin-10). As a marker of hemolysis, free hemoglobin concentrations were significantly elevated in the cCPB group. Also with regard to coagulation parameters, D-Dimer levels were increased only in the cCPB-group. However, other coagulation parameters, perioperative blood loss and transfusion requirements did not differ significantly between the three groups. In conclusion, neither the reduction of the extracorporeal priming volume nor of the foreign surface area by the SBS were able to improve global hemodynamics and to attenuate the perioperative pro-inflammatory response. KW - Extrakorporaler Kreislauf (SWD) KW - Allgemeine Entzündungsreaktion (SWD) KW - Hämolyse (SWD) KW - Koagulopathie (SWD) KW - Hämodynamik (SWD) KW - Hämodilution (SWD) LB - PUB:(DE-HGF)11 UR - https://publications.rwth-aachen.de/record/51114 ER -