Date:
January 18, 2007
Promotor:
Prof. C.J. Kalkman, MD, PhD
Co-promotores:
R. Fijnheer, MD, PhD
A.P. Nierich, MD, PhD
In this thesis, we studied the effect of the use of cardiopulmonary bypass in CABG patients on hemostasis as this may contribute to CPB-related organ dysfunction. One of our main results was that the use of CPB was associated with excessive thrombin generation and fibrinolytic activity immediately after surgery compared with off-pump procedures.
However, after off-pump coronary surgery, patients demonstrated a delayed postoperative response that became equal in magnitude to that of those having procedures with CPB in the later (20–96 h) postoperative period.
Paradoxically, we could not demonstrate an association between activation of hemostasis and the incidence of postoperative neurocognitive decline in the CPB group, whereas this could be demonstrated in the off-pump group. We found that this may partly be explained by an altered von Willebrand Factor activity by the CPB system.
In another study, we could demonstrate that baseline C-Reactive Protein values were associated with the occurence of postoperative atrial fibrillation, indepent of the use of CPB. In conclusion, the impact of the CPB system on hemostasis and inflammation in CABG patients may not be as important as assumed earlier.