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

Abstract

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.

Downregulation of DLGAP1-Antisense RNA 1 Alleviates Vascular Endothelial Cell Injury Via Activation of the Phosphoinositide 3-kinase/Akt Pathway Results from an Acute Limb Ischemia Rat Model

“…36e38 CECs shed from the vessel wall and circulate in peripheral blood, acting as sensitive markers of endothelial damage. 39,40 It was found that silencing of lncRNA DLGAP1-AS1 led to declines in MDA concentration and CK activity, affecting the recovery of CECs. Taken together, the current study found that lncRNA DLGAP1-AS1 was highly expressed in I/R, and silencing lncRNA DLGAP1-AS1 alleviated VEC injury and inflammation by means of activating the PI3K/Akt pathway in acute lower limb I/R rats The current study has some limitations.…”

Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures

“…Our general findings are also consistent with those of Mazzei et al [8] who found that the release of inflammatory markers, as well as length of intensive care unit, hospital stay, complication rate and need for allogenic transfusion were similar in the OPCAB and a Mini-HLM group. Additionally, it was shown that use of modern Mini-HLM systems as compared to CCPB is associated with significantly reduced release of circulating endothelial cells (CEC) who are considered to represent a novel and hypersensitive marker of the severe intrinsic endothelial damage with detachment of endothelial cells into the blood stream caused by CCPB [35]. Recently, CEC release in Mini-HLM procedures was found to be as low as it could be shown for OPCAB procedures.…”

Phosphorylcholine-coated extracoporeal circulation systems affect coagulation factors during cardiopulmonary bypass insufficiently: a preliminary report

“…The primary source of vWF is the vascular endothelium, which produces it without stimuli and also provides the rapid release of intracellular stores in response to other stimuli like thrombin, fibrin, and vasopressin. Wittwer et al [18] have found that increase plasma vWF levels after surgery involving CPB. During CPB, many different variables, particularly vascular endothelial injuries, can influence vWF levels.…”