Equivalence of the Acute Cytokine Surge and Myocardial Injury after Coronary Artery Bypass Grafting with and without a Novel Extracorporeal Circulation System

Murakami, Takashi; Ishibashi, Hiromi; Ohtani, Seiji; Kuroki, Kazutaka; Kurabayashi, Masahiko; Tanaka, Noriaki; Tanemoto, Kazuo

doi:10.1177/147323000503300201

Cited by 19 publications

(13 citation statements)

References 51 publications

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“…The solution was miniaturization of CBP-systems thus resulting in reduction of foreign surfaces, avoidance of blood-air contact and significant reduction of priming volume. The advantages of such minimized systems have been shown in several clinical studies so far [30,31]. Overall experience indicates an inferior biocompatibility of CCPB compared to Mini-HLM [32] which is considered to be caused by contact activation of blood cells with artificial surfaces and air, the ischemia and reperfusion injury and hemodilution.…”

Section: Resultsmentioning

confidence: 99%

Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Wittwer

Choi

Neef

et al. 2011

J Cardiothorac Surg

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BackgroundOff-pump-coronary-artery-bypass-grafting (OPCAB) and minimized-extracorporeal-circulation (Mini-HLM) have been proposed to avoid harmful effects of cardiopulmonary-bypass (CPB). Controversies exist whether OPCAB is still superior in perioperative outcome. Circulating endothelial cells (CEC) are sensitive markers of endothelial damage and are significantly elevated in conventional-CPB-procedures as compared to Mini-HLM-revascularisation. Therefore, CEC might be of specific value in evaluating effectiveness of Mini-HLM and OPCAB as currently applied less-invasive coronary procedures.Methods76 coronary patients were randomly assigned either to OPCAB (n = 34) or to Mini-HLM (ROCsafe™, Terumo Inc., n = 42) procedures. Perioperative data, clinical and serological outcome and measurements of CEC-release and parameters of endothelial function (v.Willebrand-Factor, soluble-thrombomodulin) perioperatively (pre-operative-baseline, post-Mini-HLM/release of OPCAB-stabilizer, 6 h, 12 h, 24 h and 5 days postoperatively) were obtained and compared by ANOVA models including repeated-measures-analysis.ResultsMean graft-number was 3.06 ± 0.72 in Mini-HLM-patients and 1.89 ± 0.74 in OPCAB-patients (p < 0.001). However, ventilation-, ICU- and total-hospital duration were comparable between groups as well as chest-tube-drainage, transfusion requirements, hemodynamics and catecholaminergic support (p > 0.05). CEC-release did not differ between groups (p = 0.274) and was generally within normal limits, Troponin-T levels where not significanty different (p = 0.108). No myocardial infarctions, strokes or deaths occurred, neuron specific enolase (NSE) did not show any differences between groups (p = 0.194).ConclusionConceptional advantages of minimized CPB systems (ROCsafe™) result in morbidity and mortality comparable with OPCAB procedures. Mini-HLM therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity in high-risk patients while facilitating more complete revascularization in complex patients.

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Section: Resultsmentioning

confidence: 99%

Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Wittwer

Choi

Neef

et al. 2011

J Cardiothorac Surg

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“…These have been associated with less activation of granulocytes and platelets, minimal blood transfusion, and rapid postoperative mobilization. [7][8][9][10] The advantages of MECC for coronary surgery compared with conventional OPCABG have been documented with regard to less inflammatory activation, better global organ protection, 11,12 and a reduced need for blood transfusions. 4,13 In a mixed cohort of coronary and valvular patients, MECC proved technically attainable, versatile, and reliable for full extracorporeal perfusion with satisfactory control of postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of Coronary Bypass Grafting With Minimal Extracorporeal Circulation System (MECC) Versus Off-Pump Coronary Surgery

Mazzei¹,

Nasso²,

Salamone³

et al. 2007

Circulation

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Background-We aimed to evaluate the clinical results and biocompatibility of the minimal extracorporeal circulation system (MECC) compared with off-pump coronary revascularization (OPCABG). Methods and Results-In a prospective randomized study, 150 patients underwent coronary surgery with the use of MECC and 150 underwent OPCABG. End points were (1) circulating markers of inflammation and organ injury, (2) operative results, and (3) outcome at 1-year follow-up. Operative mortality and morbidity were comparable between the groups. Release of inflammatory markers was similar between groups at all time points (peak interleukin-6 167.2Ϯ13.5 versus 181Ϯ6.5 pg/mL, Pϭ0.14, OPCABG versus MECC group, respectively). Peak creatine kinase was 419.3Ϯ103.5 versus 326Ϯ84.2 mg/dL (Pϭ0.28), and peak S-100 protein was 0.13Ϯ0.08 versus 0.29Ϯ0.1 pg/mL (Pϭ0.058, OPCABG versus MECC group, respectively). Length of hospital stay and use of blood products were similar between groups. Two cases of angina recurrence at 1 year in the MECC group were observed versus 5 cases observed in the OPCABG group (Pϭ0.44). A residual perfusion defect at myocardial nuclear scan was less frequent among patients in the MECC group (3 versus 9 cases, Pϭ0.14; odds ratio 0.32, 95% confidence interval 0.07 to 1.32). Six (OPCABG group) versus 3 (MECC group) coronary grafts were occluded or severely stenotic at 1 year (Pϭ0.33, odds ratio 0.47, 95% confidence interval 0.09 to 2.14). Conclusions-Clinical results of coronary revascularization with MECC are optimal when this procedure is performed by experienced teams. Postoperative morbidity is comparable to that with OPCABG. MECC is associated with little pump-related systemic and organ injury. It may achieve the benefits of OPCABG (less morbidity in high-risk patients) while facilitating complete revascularization in the case of complex lesions unsuitable for OPCABG. (Circulation.

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“…3 Less alveolar permeability compared to conventional CPB and capillary leak was the main finding of van Boven, et al 4 Finally, Murakami, et al have shown less cytokine surge (TNF-α, IL-8) in patients operated with the MECC system. 5 Further reports highlight the efficacy of the system pertaining to ventilation and ICU time post-operatively, since the involved patients can be "processed" in a fast-track fashion, with anesthesia adapted for a fast extubation. [4][5][6] Thus, a growing body of evidence indicates superiority of the MECC system compared to conventional CPB in cardiac and aortic surgery patients in many aspects, even though validation emerges in increments.…”

Section: Introductionmentioning

confidence: 99%

The minimized extracorporeal circulation system causes less inflammation and organ damage

et al. 2008

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The minimized extracorporeal circulation system (MECC) is being used to reduce priming volume and blood/polymer contact during cardiac procedures. In this study, we evaluated the efficacy and potential advantages of the system in coronary artery bypass graft (CABG) patients. We included two groups of patients destined for CABG in a prospective, randomized study: Group A was operated on the usual pump (n = 30) while Group B was operated using the MECC (n = 50). Pre-operative demographics, intra-operative times and values as well as a series of post-operative outcome data (blood loss, transfusion requirements, ventilation time, ICU and hospital stay) were recorded. CK, CK-MB, troponin-T, IL-6 and IL-8 were measured. Pre-operative and post-operative lung function were assessed. In the MECC-operated group, patients developed less post-operative troponin-T (0.2 +/- 0.3 vs. 0.5 +/- 0.5 ng/mL, p=0.031) and less IL-8 (13.8 +/- 5 vs. 22.5 +/- 0.5 microg/L, p = 0.05). While blood loss was comparable in both groups, packed red blood cells and fresh frozen plasma were given less frequently in the MECC group (p = 0.015 resp. 0.022). The one-tailed Student's t-test revealed shorter bypass time in the MECC group (74 +/- 17 vs. 82 +/- 24 min). There was no difference in ventilation and ICU-time (patients were not treated in a fast-track fashion). The FEV1 was better in the MECC group (relative values: 70.1 +/- 18.2% vs. 61.1 +/- 12.3%, p = 0.02). Utilization of the MECC may cause less cytokine (IL-8) liberation, owing to less blood/tubing contact, as well as less red blood cell and fresh frozen plasma demand. It may also be the circuit in patients with chronic obstructive pulmonary disease (COPD).

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Equivalence of the Acute Cytokine Surge and Myocardial Injury after Coronary Artery Bypass Grafting with and without a Novel Extracorporeal Circulation System

Cited by 19 publications

References 51 publications

Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Prospective Randomized Comparison of Coronary Bypass Grafting With Minimal Extracorporeal Circulation System (MECC) Versus Off-Pump Coronary Surgery

The minimized extracorporeal circulation system causes less inflammation and organ damage

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