THE INFLUENCE OF BIOCOMPATIBILITY OF THE EXTRACORPOREAL OXYGENATOR CIRCUIT ON THE DEGREE OF HEMOLYSIS AND OPTIMIZATION OF OXYGEN STATUS IN MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING
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Keywords

cardiopulmonary bypass
biocompatibility
hemolysis
coronary artery bypass grafting
oxygen delivery
oxygen consumption

How to Cite

Cherniy, V. I., Sobanska, L. O., Topolov, P. O., & Grygorieva, A. V. (2024). THE INFLUENCE OF BIOCOMPATIBILITY OF THE EXTRACORPOREAL OXYGENATOR CIRCUIT ON THE DEGREE OF HEMOLYSIS AND OPTIMIZATION OF OXYGEN STATUS IN MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING. Clinical and Preventive Medicine, (1), 65-71. https://doi.org/10.31612/2616-4868.1.2024.08

Abstract

Introduction. A distinctive feature of cardiopulmonary bypass in minimally invasive coronary artery bypass grafting (CABG) is the significantly longer perfusion time, involving active blood drainage from the vein to the cardiotomy reservoir, which carries the risk of hemolysis development. In this context, mechanical hemolysis disrupts the gas transport function of the blood.

The aim of the research. Reducing hemolysis and optimizing oxygen status of patients during minimally invasive coronary artery bypass grafting surgeries.

Materials and methods. The study included 60 patients, who underwent minimally invasive coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) under moderate hypothermia. The patients were divided into two groups of 30 individuals each. To improve the biocompatibility of the oxygenator, the circuit in Group 1 (Gr1) was treated with an adaptive composition, while in Group 2 (Gr2), the oxygenator circuit remained untreated. The following parameters were examined: hemoglobin (Hb), hematocrit (Ht), red blood cell count (RBC), oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen extraction ratio (O2ER%), oxygen extraction index (O2EI%), venous (SpvO2), and arterial (SpaO2) oxygen saturation, oxygen tension in arterial (PaO2) and venous blood (PvO2), acid-base status of the blood (pH, pCO2,HCO3ˉ, BE), and the degree of hemolysis.

Results. Before initiation of cardiopulmonary bypass (CPB), an insignificant increase in O2IE% was observed in Gr1 (26.07±1.57) and Gr2 (27.11±0.81); p=0.875, indicating an increase in tissue oxygen consumption. At the hypothermic stage CPB, both Gr1 and Gr2 demonstrated a statistically significant decrease in Hb, Ht, and RBC levels (p<0.05) due to hemodilution, accompanied by a decrease in IDO2, IVO2, O2IE%, and O2ER% in both groups due to hypothermia. After rewarming, O2ER% in Gr1 (22.91±2.68) and Gr2 (24.59±2.02); p=0.191, and O2EI% in Gr1 (22.92±2.44) and Gr2 (24.61±2.01); p=0.215, were in the normal range. After weaning off cardiopulmonary bypassin Gr2, O2EI% was 27.34±1.97, indicating an increase in oxygen consumption and oxygen extraction. Upon separation from CPB, Gr2 showed a tendency to mild compensated metabolic acidosis, mainly due to HCO3ˉ 21.9±0.3. During the rewarming stage, the hemolysis value was 0.36±0.09in Gr1 and 0.45±0.17 in Gr2 (p<0.001). After CPB, hemolysis was 0.41±0.15 in Gr1 and 0.61±0.22 in Gr2 (p<0.001).

Conclusions. Improving the biocompatibility of the extracorporeal oxygenatorcircuit makes it possible to reduce hemolysis and optimise the patient's oxygen status after cardiopulmonary bypass in minimally invasive coronary artery bypass grafting.

https://doi.org/10.31612/2616-4868.1.2024.08
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References

Aydin, S., Cekmecelioglu, D., Celik, S., Yerli, I., Kirali, K. (2020). The effect of vacuum-assisted venous drainage on hemolysis during cardiopulmonary bypass. Am J Cardiovasc Dis., Oct 15, 10(4), 473-478. PMID: 33224598; PMCID: PMC7675161

Bhirowo, Y.P., Raksawardana, Y.K., Setianto, B.Y., Sudadi, S., Tandean, T.N., Zaharo, A.F., Ramsi, I.F., Kusumawardani, H.T., Triyono T. (2023). Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors. J Cardiothorac Surg., Oct 13,18(1),291. doi: 10.1186/s13019-023-02406-y. PMID: 37833747; PMCID: PMC10571250

Olia, S.E., Maul, T.M., Antaki, J.F., Kameneva, M.V. (2016). Mechanical blood trauma in assisted circulation: sublethal RBC damage preceding hemolysis. Int J Artif Organs., Jun 15, 39(4), 150-9. doi: 10.5301/ijao.5000478. Epub 2016 Mar 30. PMID: 27034320; PMCID: PMC4928574.

Lee, S.S., Ahn, K.H., Lee, S.J., Sun, K., Goedhart, P.T, Hardeman, M.R. (2004). Shear induced damage of red blood cells monitored by the decrease of their deformability. Korea-Australia Rheology Journal.,16(3),141–146.

Mizuno, T., Tsukiya, T., Taenaka, Y., et al. (2002). Ultrastructural alterations in red blood cell membranes exposed to shear stress. ASAIOJ., 48(6), 668–670. [PubMed: 12455781

Olia, S.E., Maul, T.M., Antaki, J.F., Kameneva, M.V. (2016). Mechanical blood trauma in assisted circulation: sublethal RBC damage preceding hemolysis. Int J Artif Organs., Jun 15, 39(4),150-9. doi: 10.5301/ijao.5000478. Epub 2016 Mar 30. PMID: 27034320; PMCID: PMC4928574.

Topolov P. ., Dʹordyay I. S., Sobansʹka L. O. ta in. (2018). Vplyv obrobky oksyhenatora adaptatsiynoyu kompozytsiyeyu pid chas aortokoronarnoho shuntuvannya na zminu klityn krovi [Effect of treatment of oxygenator with adaptation composition during aortocoronary shunting on the change of blood cells]. Heart and blood vessels. №1 (61), 80-83.

Cherniy, Volodymyr. І., Sobanska, Lada. O. (2021). Method of erythrocyte protection in urgent cardiac surgery. Emerg Med Serv., VIII, 68-74. DOI: 10.36740/EmeMS202102103

Aston, D., Zeloof, D., Falter, F. (2023). Anaesthesia for Minimally Invasive Cardiac Surgery. J Cardiovasc Dev Dis., Nov 15, 10(11), 462. doi: 10.3390/jcdd10110462. PMID: 37998520; PMCID: PMC10672390.

Parnell, A., Prince, M. (2018). Anaesthesia for minimally invasive cardiac surgery. BJA Educ., Oct, 18(10), 323-330. doi: 10.1016/j.bjae.2018.06.004. Epub 2018 Aug 28. PMID: 33456797; PMCID: PMC7807915

Salenger, R., Morton-Bailey, V., Grant, M., Gregory, A., Williams, J.B., Engelman, D.T. (2020). Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation. Semin Thorac Cardiovasc Surg., Summe, 32(2), 187-196. doi: 10.1053/j.semtcvs.2020.02.029. Epub 2020 Feb 29. PMID: 32120008.

Aleksyeyeva, T.A., Lazarenko O.N. (2016). CoLtd "Mabela"CO Ltd MABELA. Substance enhancing biocompatibility of implants with recipient body and method of its preparation patent application European patent, 2709684B1. May 25.

Cherniy, V., &Sobanska, L. (2020). The use of a multicomponent hyperosmolar priming volume oxygenator during cardiopulmonary bypass surgeries. EMERGENCY MEDICINE, 16(5), 114–122. https://doi.org/10.22141/2224-0586.16.5.2020.212232

Leach, R. M., &Treacher, D. F. (1992). The pulmonary physician and critical care. 6. Oxygen transport: the relation between oxygen delivery and consumption. Thorax, 47(11), 971–978. https://doi.org/10.1136/thx.47.11.971

Kornilov I.A., Ponomarev D.N., Shmyrev V.A., Skopets A.A., SinelnikovYu.S., Lomivorotov V.V. (2016). Physiological parameters of artificial blood circulation from the position of the evidence based medicine (part 2). Messenger of anesthesiology and resuscitation., 13(3), 29-42. (In Russ.) https://doi.org/10.21292/2078-5658-2016-13-3-29-42

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