Drew-Anderson Technique attenuates systemic inflammatory response syndromeand improves respiratory function after coronary artery bypass grafting

Background. Cardiopulmonary bypass causes inflammatory reactions leading to organ dysfunction postoperatively. This study was undertaken to determine whether using patients' own lungs as oxygenator in a bilateral circuit (Dre w-Anderson Technique) could reduce systemic inflammatory response to cardio pulmonary bypass, improving patients clinical outcome following coronary ar tery bypass grafting. Methods. A prospective randomized controlled trial involving 30 patients, d ivided in two groups of 15 patients each, undergoing elective coronary arte ry bypass grafting, was undertaken. In the Drew-group bilateral extracorpor eal circulation using patient's lung as oxygenator was performed. The other patients served as control group, where standard cardiopulmonary bypass pr ocedure was used. Results. pro-inflammatory and anti-inflammatory mediators were measured. Pe ak concentrations of pro-inflammatory interleukin-6, interleukin-8, were si gnificantly lower in 15 patients undergoing Drew-Anderson Technique compare d with the concentrations measured in 15 patients treated with standard car diopulmonary bypass technique. Differences in patient recovery were analyze d with respect to time of intubation, blood loss, intrapulmonary shunting, oxygenation, and respiratory index. In patients undergoing uncomplicated co ronary artery bypass grafting procedures bilateral extracorporeal circulati on using the patients' own lung as oxygenator provided significant biochemi cal and clinical benefit in comparison to the standard cardiopulmonary bypa ss procedure. Conclusions. This prospective randomized clinical study has demonstrated th at exclusion of an artificial oxygenator from cardiopulmonary bypass circui t si,significantly decreases the activation of inflammatory reaction, and t hat interventions that attenuate this response may result in more favorable clinical outcome. (C) 2000 by The Society of Thoracic Surgeons.