Eptifibatide infusion versus placebo in high risk patients with non-st segment elevation acute coronary syndromes managed with urgent coronary artery bypass graft surgery. a prospective multicenter randomized placebo-controlled clinical trial.

AIM: This randomized prospective clinical trial aimed to evaluate safety and efficacy of preoperative use of eptifibatide in high risk patients with non--ST--segment elevation acute coronary syndrome (NSTE--ACS), requiring urgent coronary artery bypass graft surgery (CABG). METHODS: A total of 140 patients with NSTE--ACS eligible for urgent surgical revascularization received either eptifibatide (bolus plus infusion) 12--48 hours prior to surgery (n=72 patients) or placebo (normal saline; n=68 patients) followed by routinely administered enoxaparin and aspirin. Patients were regarded as unsuitable for percutaneous coronary intervention by the heart team. CABG was performed 4 hours after discontinuation of eptifibatide or placebo infusion. The primary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as death, nonfatal myocardial infarction (MI), stroke and the need for re--hospitalization due to recurrent ischaemia at 12 months follow--up. Secondary endpoints included MACCE rate at 1 month, bleeding complications, platelet inhibition efficacy and correlation of platelet activity with MACCE rate. RESULTS: Cumulative one year MACCE rate was 35% vs 14% in the control and treated group respectively (p=0.012). Mortality rate at 30 days follow--up was 10% vs 3% (p=0.021) and was not changed at 12 months follow--up. There was a significant difference between both groups regarding perioperative MI (22% vs. 8%, p=0.03). The rates of stroke, blood loss and blood transfusion were similar in both groups. CONCLUSION: Preoperative use of eptifibatide vs. placebo is linked to significantly reduced 12--month MACCE rate in patients with NSTE--ACS requiring urgent CABG, while it simultaneously seems not to confer a greater risk of postoperative bleeding.

Bypass surgery versus percutaneous coronary intervention for the treatment of unprotected left main disease. A meta-analysis of randomized controlled trials.

OBJECTIVE: We performed a meta-analysis of randomized controlled trials to compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of de novo unprotected left main disease. BACKGROUND: Although CABG is accepted to be standard of care for revascularization of unprotected left main stenosis, PCI is increasingly being used as an alternative primary approach. METHODS: We searched for randomized, controlled trials comparing CABG and PCI for the treatment of unprotected left main disease. Major adverse cardiac and cerebrovascular events (all-cause death, myocardial infarction, stroke, and repeat revascularization) were analyzed. RESULTS: The search strategy identified 4 randomized controlled trials enrolling a total of 1,611 patients. Follow-up ranged between 1 and 2 years. There were no significant differences in the risk of death or myocardial infarction between the two treatment modalities. While the risk of stroke was significantly lower in patients undergoing PCI (risk ratio (RR) 0.26, 95% confidence interval (CI) 0.10-0.69, p = 0.007), the risk of repeat revascularization was higher among patients undergoing PCI (RR 1.94, 95% CI 1.43-2.61, p < 0.001). No relevant statistical heterogeneity across studies could be found. CONCLUSION: In this largest series of randomized patients with unprotected left main stenosis to date, the risk of death and myocardial infarction was comparable between CABG and PCI. However, patients undergoing CABG had a higher risk of stroke, whereas patients undergoing PCI were at a higher risk for repeat revascularization.

Prediction of the excessive perioperative bleeding in patients undergoing coronary artery bypass grafting: role of aspirin and platelet glycoprotein IIIa polymorphism.

OBJECTIVE: The presence of the glycoprotein IIIa allele PlA2 is associated with enhanced thrombin formation and an impaired antithrombotic action of aspirin, which could favor coronary thrombosis. We wondered whether PlA1/A2 genetic polymorphism could affect the postoperative bleeding in patients undergoing coronary artery bypass grafting. We also aimed to assess the effects of aspirin pretreatment and to ascertain the value of platelet function studies as predictors of postoperative bleeding. METHODS: In a randomized, double-blind study, patients undergoing coronary artery bypass grafting were pretreated with a 150-mg dose of aspirin orally 12 and 3 hours before surgery (n = 51, 41 elective) or with placebo (n = 51, 43 elective). The hemostasis was monitored by Simplate (bioMérieux, Inc, Durham, NC) bleeding time and capillary closure time (platelet function analyzer PFA 100; Sysmex UK Ltd, Milton Keynes, United Kingdom). Postoperative bleeding and blood products transfusions were recorded. The glycoprotein IIIa polymorphism was analyzed. RESULTS: Bleeding was significantly greater in PlA1 homozygotes from control group. Blood loss was significantly greater (by 25%) in aspirin group. The volume of blood products transfusions in aspirin patients was significantly larger (by 137%). When subjects were stratified accordingly to blood platelet glycoprotein IIb/IIIa genotype, in the aspirin group PlA2 carriers had greater blood loss than PlA1 homozygotes (1858 +/- 932 mL vs 1216 +/- 525 mL, P < .05). CONCLUSION: PlA1 homozygotes normally had a greater risk of perioperative bleeding. Capillary closure time had no advantage relative to Simplate bleeding time in predicting postoperative blood loss. Aspirin pretreatment revealed no beneficial effects and resulted in increased postoperative bleeding and requirement for blood product transfusions after coronary artery bypass grafting in patients with stable angina. It was most unfavorable for PlA2 carriers.

Traumatic rupture of the aorta in adolescence--description of two cases.

Aortic disruption is a well documented cause of death in motor vehicle accidents and falls from heights. These injuries also affect children. About 10 % who survive despite aortic injury could potentially be saved provided the diagnosis is established and surgical intervention is undertaken early enough. We present here 2 cases of adolescents aged 17 years, treated in our hospitals with different results. In the first case, timely diagnosis of aortic pseudoaneurysm could not be made, which resulted in its rupture and the death of the patient. In the other patient an early diagnosis of aortic injury was established already in the Emergency Department. The patient was then transferred for further surgical treatment which proved successful. Diagnosis of traumatic aortic rupture is impossible at the accident site and can also be missed in hospital. The symptoms of aortic rupture are not characteristic. The knowledge of the mechanism of injury is extremely important. The diagnosis is established based on chest X-ray, computed tomography, and transoesophageal echocardiography. In cases of doubt, aortography remains decisive in the identification of an aortic injury.

Prevalence of Helicobacter pylori infection in Polish shepherds and their families.

BACKGROUND: Helicobacter pylori infection might, in some instances, be considered as zoonosis. AIM: The aim of this study was to assess the H. pylori prevalence in Polish shepherds and in their families as compared to controls. Patients and methods. A total of 42 shepherds from Polish Tatra Mountains with regular contact with sheep, 28 members of their families with incidental contacts and 61 age- and gender-matched farmer controls without such contacts were involved in this study. H. pylori status was determined by 13C-urea breath test. Serology was used to measure anti-H. pylori and anti-CagA IgG. Plasma gastrin, interleukin-8 and tumor necrosis factor-alpha were also determined. RESULTS: The H. pylori prevalence reached 97.6% in shepherds, 86% in their family members, but significantly less, 65.1%, in controls without contact with sheep. Anti-H. pylori IgG, anti-CagA in contact groups were significantly higher than in controls. Also, plasma gastrin, interleukin-8 and tumor necrosis factor-alpha had significantly higher values as compared to controls. CONCLUSIONS: Shepherds showed almost 100% H. pylori prevalence and higher incidence of CagA seropositivity, plasma gastrin and pro-inflammatory cytokine levels. Considering 100% positive 13C-urea breath test in sheep, it may be reasonable to suggest that H. pylori infection in shepherds and their family members originates from sheep and H. pylori infection might, therefore, be considered as zoonosis.

Long term left ventricular systolic function assessment following CABG. A prospective, randomised study. Blood versus cristalloid cardioplegia.

BACKGROUND: In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ventricular function undergoing elective coronary artery bypass surgery, we initiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/retrograde crystalloid cardioplegia. METHODS: To compare the efficiency of two methods of myocardial protection--cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardioplegia in two groups of patients with high and low LVEF--we randomised 122 patients for CABG. The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the end points of the study. Patients were divided into group I (47 patients, LVEF <40%) and group II (75 patients, LVEF >40%). Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardioplegia). The following parameters were measured: left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular wall motion score index (WMSI), and area asynergy (AA). All patients underwent echocardiography: A--prior the CABG, B--2-6 weeks postoperatively, C--3 months postoperatively, D--6 months postoperatively, E--1 year postoperatively. RESULTS: The results of clinical assessment in both groups showed improvement of quality of life. The constant improvement of LVEF and WMSI was observed in group I in contrast to group II. There were no significant differences in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb. CONCLUSIONS: The use of blood cardioplegia, instead of crystalloid cardioplegia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function. The improvement in left ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.

Minimally invasive saphenous vein harvesting for coronary artery bypass grafting--comparison of three less invasive methods.

INTRODUCTION: Saphenous vein is routinely harvested using one or a few long continuous skin incisions. This method is associated with typical healing complications such as oedemas, pain, necrosis, what often restricts proper rehabilitation. An alternative minimally invasive techniques may decrease these complications. MATERIAL AND METHODS: This prospective randomised trial compared outcomes associated with saphenous vein harvested using three minimally invasive techniques versus a traditional longitudinal incision. RESULTS: In the less invasive group we observed statistically significant improvement in all estimated parameters of wound healing, oedemas and pain. We present also costs analysis between the groups. CONCLUSIONS: We conclude that less invasive techniques of saphenous vein harvesting may be alternatively introduced in coronary bypass surgery.

Cardiac troponin T release during coronary surgery using intermittent cross-clamp with fibrillation, on-pump and off-pump beating heart.

OBJECTIVE: Troponin T is a unique marker which might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. The aim of the study was a comparison between intra-operative release of troponin T (TnT) during three different myocardial protection strategies. METHODS: Thirty-eight PTS undergoing myocardial revascularization were randomised into 3 groups in whom procedure was performed with intermittent cross-clamp (Group I; n = 13), beating-heart on pump without aortic cross-clamp (Group II; n = 12), beating-heart without use of extracorporeal circulation (Group III; n = 13). Serial venous blood samples were collected for TnT measurement prior surgery, 1, 4, 12, 24, 48, 72 h after the procedure. Haemodynamic measurements were made using a thermodilution PA catheter. RESULTS: The groups were similar with respect to age, sex, preoperative LV function, number of grafts, potential risk factors. There were no hospital deaths and no myocardial infarction (MI) in three groups, postoperative haemodynamic measurements showed no significant differences. TnT serum levels were significantly higher in group I when compared to groups II and III. TnT levels were significantly lower in group Ill when compared to group II following 48-h post-operation. CONCLUSIONS: Coronary bypass grafting without aortic cross-clamping and without CPB offers superior myocardial protection.

Evaluation of perioperative myocardial tissue damage in ischemically preconditioned human heart during aorto coronary bypass surgery.

BACKGROUND: Preconditioning myocardium with short periods of ischaemic stress interspersed with reperfusion increases its resistance to infarction. Ischaemic preconditioning protection occurred in human beings during unstable angina preceding myocardial infarction, during percutaneous transluminal coronary angioplasty and during aorto coronary bypass surgery. The purpose of this study was to test (utilised cardiac troponin T measurement) whether ischaemic preconditioning was able to protect myocardial tissue during the perioperative period and how long that protection lasted. METHODS: Patients were recruited to the preconditioned group (n=29), received 4-min of aortic cross-clamping and 6 min reperfusion prior to CABG performed with intermittent ischaemic arrest and the control group (n=27) received only an ischaemic insult of operating procedure. TnT measurements were determined from blood samples taken before surgery (A), 1 hour after onset of CPB (B), 4 hours (C), 8 hours (D), 12 hours (E), 24 hours (F), 48 hours (G) and 72 hours after CPB (H). RESULTS: Results were expressed as the median, range and standard deviation (SD) of TnT concentration (microg/l). Ischaemic preconditioning decreased TnT concentration with statistical significance 1 hour after onset of CPB (preconditioned B: median 0.12+/-0.25 vs control B: median 0.32+/-0.43, p=0.03). There were notable differences in TnT concentration in C, D, E, F, G, H blood samples between the control and the preconditioned group but with p value of no statistical significance. CONCLUSIONS: These data illustrate that ischaemic preconditioning limits myocardial damage during operative procedure and it may probably afford protection during a postoperative period.

[Surgical revascularization of the myocardium in patients with chronic coronary disease and depressed left ventricular function: 1-year observation]. / Chirurgiczna rewaskularyzacja miesnia sercowego u chorych z przewlekla choroba niedokrwienna serca i uposledzona czynnoscia lewej komory: 1-roczna obserwacja.

Many reports confirm the importance and benefit of the surgical revascularization (CABG) in patients with ischemic heart disease and severely depressed left ventricular (LV) systolic function. This mode of treatment is better than medical therapy in patients with very low LV ejection fraction (LVEF) and can prolong the life. However, the effect of CABG on LV hemodynamics is still unclear. The aim of the study was: 1) to assess the effect of CABG on LV hemodynamics in patients with low LVEF and 2) to examine the influence of two types of cardioplegia-crystalloid (CC) and blood (BC) cardioplegia--on LV function during 1 year follow-up. 122 patients with stable angina pectoris qualified for CABG were included in the study. Patients were divided into two groups: group I-47 pts with LVEF < or = 40% and group II--75 pts with LVEF > 40% and then patients were randomized for two types of antegrade-retrograde cardioplegia (CC--subgroups Ia, IIa and BC--subgroups Ib, IIb). Before operation and 4 times after CABG (after 2-6 weeks, 3 months, 6 months and 1 year) echocardiographic examination was performed. Diameters of left atrium and ventricle, LVEF and wall motion score index (WMSI) were calculated. During 1 year 8 patients died (5 of them during perioperative period and 3 patients during follow-up). Patients in group I before operation were in higher NYHA and CCS class and had more often myocardial infarction. During each of the five echocardiographic examination the values of LVEF and WMSI did not differ between subgroups Ia vs Ib and IIa vs IIb. In group I, especially in patients with very low LVEF < or = 30%, the values of LVEF and WMSI improved significantly (p < 0.001) during 1 year of follow-up. But in group II a transient deterioration of LVEF (p < 0.05) 2-6 weeks after CABG was noted. We conclude that surgical revascularization in patients with severe depressed hemodynamics improves LV systolic function during 1 year follow-up. The use of CC or BC did not seem to make any difference to the early and long-term hemodynamic effect of the revascularization.

The use of exogenous creatine phosphate for myocardial protection in patients undergoing coronary artery bypass surgery.

A key component in the development of ischemic functional and structural myocardial injury during cardiosurgical procedures is an inadequate cellular energy supply which occurs as a consequence of the cessation of oxidative metabolism. In such conditions high energy phosphates are rapidly depleted. As they play a critical role in the maintenance of cell viability and postischemic recovery of contractile function, their conservation is therefore a primary objective in any procedure designed to reduce ischemic injury. Exogenous administration of phosphocreatine (CP) has been suggested as being beneficial to the ischemic heart. The aim of present study was to evaluate the possible cardioprotective effect of exogenous CP during coronary artery surgery (CABG). Forty patients undergoing CABG procedure were randomly assigned to receive creatine phosphate-enriched (group I) or standard-St. Thomas' Hospital (group II) cardioplegic solution; each group comprised 20 patients. Group I received: 6.0 g of exogenous CP (Neoton) daily in two 20-min intravenous infusions during 3 days preoperatively; during surgical procedure they were administered standard cardioplegic solution enriched in CP at the concentration of 10 mmol/l and -- 2 days postoperatively -- 4.0 g CP daily in two intravenous injections. Group II did not receive CP at all In both groups were analysed. Haemodynamic parameters. Continuous 48-h ECG recording (Holter monitoring) outcome. Laboratory values of serum CK and CK-MB. Inotropic support required (drugs, mechanical support). Ultrastructural findings (biopsy data). Statistical analysis was carried out using Student's "t"-test and the chi2 test. Values of p<0.05 were taken as the criterion of significant difference. The results of the study were: Significantly lower average number and energy of DC-shocks needed to restore cardiac function after cardiopulmonary bypass procedure in group 1. Statistically significant beneficial effect on the presence of ventricular arrhythmias during surgery and in early postoperative period in group I. Significantly lower requirements for inotropic drugs postoperatively in group I. Statistically significant lower degree of sarcolemmal damages in myocardial biopsies in group I. Concluding, the authors wish to state that: Exogenous phosphocreatine (Neoton) perioperative administration in coronary artery bypass patients reduced the need for inotropic drugs, which is clinically manifested in lower frequency of low cardiac output syndrome. Perioperative administration of exogenous CP improves electrophysiological stability of the myocardium. Advantageous clinical and electrophysiological effect of exogenous CP may result from its properties to protect sarcolemma of the cardiomyocytes.

Coronary arteries bypass grafting with use of both internal thoracic arteries.

The internal thoracic artery is a preferred conduit for bypass grafting. While the single ITA grafting has been universally accepted -- the use of both ITA's remains controversial. The risk factors analysis based upon assessment of operative results and mid-term functional follow-up was performed. The clinical applicability of transthoracic B-mode ultrasonic imaging and Doppler spectrum analysis in the postoperative evaluation of use of two ITA's was investigated. From January 1989 to January 1993, 97 patients received bilateral ITA and additional vein or RGEA grafts at Groby Road Hospital, Leicester, UK. There were 77 men (79.4%) and 20 women (20.6%) with mean age of 52.1+/-10.1 years. 19 cases were urgent. 14.4% of patients suffered from diabetes mellitus, 8.3% -- COAD and 46.6% did not work because of angina. The average number of anastomoses per patient was 3. The operative mortality was 4.1%. Complications included: reoperation for bleeding=3.2%, sternal infection=6.5%, IABP=2.1%. There were no evidence of perioperative myocardial infarction. 80 patients were followed-up for 26,5+/-13 months. 49 patients were in angina NYHA class I while preoperatively: 7. 1 patient was in NYHA class III while preoperatively there were 40 patients. Nearly twice more patients worked, and more than three times fewer patients did not worked because of angina, comparing to preoperative period. With the use of colour Doppler technique the blood flow was measured in 78.3% of left and 74% of right ITA's. The average flow in left ITA was: 46.4+/-17 ml/min and 41.7+/-17 ml/min in right ITA. The multivariate analysis for risk factors of bilateral ITA's grafting was performed. There were no risk factors for postoperative complications of bilateral internal thoracic arteries grafting in presented material. The risk of perioperative death is higher for patients with triple vessels disease than for patients with double vessels disease. Bilateral ITA grafting procedure has positive influence on patients working abilities. Percutaneous ultrasonic assessment of flow in ITA's used for bypass appears to be useful non-invasive investigation of their function.

[Collagen metabolism disturbances with experimentally increased pulmonary flow--experimental model of left to right shunt with congenital heart defects in children]. / Zaburzenia metabolizmu kolagenu w doswiadczalnie wywolanym zwiekszonym przeplywie plucnym--model eksperymentalny przeciekowych wad wrodzonych serca u dzieci.

The studies carried out on young piglets were to demonstrate that experimentally increased pulmonary flow resulted in collagen hyperproduction in the pulmonary tissue. In 14 piglets a modified Blalock-Taussig anastomosis was performed, 9 animals constituted the controls. The survivors included 9 experimental and 8 control piglets. In direct lung biopsies the biochemical collagen content was assessed, whereas histopathology confirmed the development of vascular lesions characteristic for pulmonary hypertension. A significant increase of collagen level in the pulmonary tissue was demonstrated in experimental animals. Determinations were also made of serum and urine hydroxyproline values. A significant increase was observed in serum and urine hydroxyproline values in experimental animals in comparison to the controls when determinations were made 7 days to 3 months after the anastomosis had been performed (p < 0.01). The authors showed that an increase of pulmonary flow in piglets results in collagen metabolism disturbances which are seen both in an increased collagen level in the tissue and in increased serum and hydroxyproline levels.

[Hydroxyproline in serum and urine in children with pulmonary hypertension in the course of congenital heart defects]. / Hydroksyprolina w surowicy i moczu u dzieci z nadcisnieniem plucnym w przebiegu przeciekowych wad wrodzonych serca.

In accordance to contemporary views on the pathology of biochemical changes in the fibrotic process at pulmonary hypertension, the authors took a trial to investigate the convection of excessive blood flow through lungs and changes of collagen metabolism in lungs. The possibility of following the metabolism of collagen through naming its metabolites (hydroxyproline-Hp) made us to connect the intended surveys with practical trail of its use, and diagnostic methods at children with congenital shunt cardiac defects. The survey was taken up in three groups of children with different levels of pulmonary advancement hypertension process: 39 children with dynamic elevation of pulmonary artery pressure (I st and II nd group age range: 12 months to 2 years), and 17 children with marks of pulmonary vascular obstructive disease. III rd group age range: 12 months to 6 years. It was stated, that between children from the first and second group before operational treatment, clear growth of Hp contents in serum and in urine returned to its correct value within the 1 to 6 months observation period since the cardiac defect has been corrected. In the third group, in spite of surgical treatment, the increased Hp content remained in the post operative period, therefore testifying the non-retreated fibrotic changes. It was stated, that Hp content control in serum and excretion in urine can possess clinical usage as an auxiliary exam estimating the advancement of pulmonary hypertension before surgical treatment and at the post-operative monitoring of the lungs.

[Angioplasty of the ostium of the left coronary artery using a venous patch]. / Plastyka ujscia lewej tetnicy wiencowej przy uzyciu laty zylnej.

Isolated critical ostial stenosis of the left main coronary artery (LMCA) without narrowing in the distal parts of coronary vessels is rather rare cause of angina. It was observed in 7 our patients: 5F and 2M aged 42-55 yrs (mean 47.5). Five of them were in unstable condition. In all of them a direct surgical angioplasty of the LMCA was performed. Cardiopulmonary bypass with moderate hypothermia were used in all patients. The LMCA was approached from behind. A curved incision was made into the right lateral aortic wall toward the LMCA. Care was taken to stay away from the commissure between the noncoronary and the left coronary cusp. The posterior aspect of the LMCA was incised across the stenosis and prolonged through bifurcation. A venous onlay patch was used to enlarge not only the LMCA but also the adjacent 2 cm of aortic incision, so as to give the LMCA ostium a funnel shape, which favors a homogeneous blood flow. The mean aortic cross clamping time was 46 min. The patients were easily weaned from cardiopulmonary bypass. The early and late results are good--all patients were discharged from the hospital free of symptoms. In 6 patients a perfect patency of the left main stem was documented during control coronarography. In our opinion direct surgical angioplasty of LMCA is better then the conventional surgical treatment because normal geometry of LMCA ostium and normal blood flow can be restored using this method.

Electrophysiologic properties of transplanted human heart with and without rejection.

Twelve male heart transplant recipients underwent routine electrophysiologic evaluation. None were taking cardioactive drugs, and only two had symptoms of arrhythmia. Two patients had endocardial VVI pacemakers because of previous early sinus node dysfunction. With simultaneous endomyocardial biopsy, we found seven patients with no evidence of rejection (group 1) and five patients with mild rejection (group 2; three initial or mild; two definite rejection). In two group 1 patients with presyncope, corrected sinus node recovery time was prolonged, and pacemakers were implanted into the endocardium. In all patients atrioventricular conduction was normal. One patient had evidence of functional duality of anterograde atrioventricular nodal conduction. In group 2 patients prolongation of effective refractory period of the donor atrium, functional refractory period of the atrioventricular node, and effective refractory period of the right ventricle were observed. This prolongation of refractoriness may be one of the earliest markers of rejection.

Biocompatibility of extracorporeal circulation with autooxygenation.

Platelet damage, complement activation and neutropenia during cardiopulmonary bypass are the result of blood contact with artificial surfaces, mainly in the oxygenator. To evaluate biocompatibility of this kind of bypass we compared two techniques of extracorporeal circulation in 40 patients undergoing elective coronary bypass operations. In 20, a standard technique with a bubble oxygenator was used (group 1), and in the remaining 20 patients with autooxygenation, the patients' own lungs were included in the perfusion circuit (group 2). Several blood samples were taken before, during and after perfusion to estimate the corrected platelet numbers and pulmonary leucocyte sequestration in all patients, and additionally in 6 patients from each group, complement C3a and C5a anaphylatoxins were measured (radioimmunoassay). At the end of cardiopulmonary bypass, the decline of platelet number corrected to haematocrit platelet number in group 1 was significantly higher than in group 2 (P less than 0.01). There was a significant increase in circulating white blood cells when compared to pre-bypass time in both groups (P less than 0.05). However, comparison of differences between leucocyte counts in the blood of the patients' right and left atria showed enhanced leucocyte sequestration in group 1, 1.46 +/- 0.5 x 10(3)/mm3 vs only 0.34 +/- 0.2 x 10(3)/mm3 in group 2. The C3a rose progressively during extracorporeal circulation: in group 1 from 268 +/- 46 ng/l to 521 +/- 65 ng/l, and in group 2 from 244 +/- 46 ng/l to 418 +/- 34 ng/l (P less than 0.05). No characteristic changes in C5a activation were observed in either group.(ABSTRACT TRUNCATED AT 250 WORDS)