According to Gravlee, which component is primarily responsible for thrombin generation and the inflammatory response?

The surgical pericardial wound is primarily responsible for thrombin generation and the inflammatory response due to its significant role in exposing blood to tissue factors and collagen that initiate the coagulation cascade. When the pericardium is surgically compromised, there is an influx of tissue factor that activates the extrinsic pathway of coagulation, leading to thrombin generation. This process is crucial because thrombin not only plays a key role in hemostasis but also acts as a pro-inflammatory mediator, thereby contributing to the systemic inflammatory response often seen during and after surgery.

In contrast, while the CPB circuit, cell saver, and oxygenator play important roles in perfusion and circulation, they are not primarily responsible for initiating thrombin generation and the inflammatory response in the same way that a surgical pericardial wound is. The CPB circuit serves as a mechanical means of oxygenation and perfusion, the cell saver is used for blood recovery, and the oxygenator mainly focuses on gas exchange and maintaining oxygen levels in the blood. These components can contribute to overall patient management during surgery, but the direct activation of the coagulation and inflammatory pathways through a surgical wound is pivotal during surgical procedures.