Systemic and Myocardial Inflammatory Response in Coronary Artery Bypass Graft Surgery With Miniaturized Extracorporeal Circulation

Abstract

Inflammatory response and hemodilution are the main drawbacks of extracorporeal circulation. We hypothesize that the use of miniaturized extracorporeal circulation (MECC) might lower the systemic and myocardial inflammatory patterns compared with a standard system (SECC) and off-pump coronary artery bypass grafting (OPCABG). Sixty-one patients undergoing isolated coronary artery bypass graft were prospectively randomized to MECC (n = 19), SECC (n = 20), or OPCABG (n = 22). Blood samples were collected from radial artery and coronary sinus to analyze blood lactate, hemodilution, and markers for inflammation and endothelial activation such as tumor necrosis factor (TNF)-α, interleukin-6, monocyte chemotactic protein-1, and E-selectin. No differences were observed in early clinical outcome. Interleukin -6 levels increased in every group during and after cardiac surgery, whereas TNF-α values grew in the SECC group (p = 0.05). E-selectin systemic values decreased during and after operation (p = 0.001) in every group. Monocyte chemotactic protein-1 systemic and cardiac levels raised only in SECC group (p = 0.014). In conclusion, MECC is comparable to SECC and OPCABG in the clinical outcome of low-risk patients, and it might be extensively used with no additional intraoperative risk. The analysis of the inflammatory patterns of endothelial activation shows MECC as effective as OPCABG, suggesting further studies to clarify MECC recommendation in high-risk patients.

Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis

“…258 The robustness and stability of the results were confirmed in sensitivity analyses. 259 The current 2014 ESC guidelines on myocardial revascularization assign class IIa level B 260 recommendation to performing OPCAB in high risk patients in high-volume off-pump centers 261 [25]. ACC/AATS 2011 guidelines recommend OPCAB in patients with renal impairment and 262 suggest to consider beating heart revascularization in order to reduce perioperative bleeding 263 and the need for transfusions [26].…”

Perioperative Outcomes, Transfusion Requirements, and Inflammatory Response after Coronary Artery Bypass Grafting with Off-Pump, Mini-Extracorporeal, and On-Pump Circulation Techniques

“…14 Several previous studies have investigated plasma level differences (postoperative - preoperative) in IL-6 and CRP between OPCAB and MECC 9,11,15,16 9,11,15,16 9,11,15,16 9,11,15,16 or MECC and ONCAB, 5 all of which failed to demonstrate significance. Our study is the first that has compared serum inflammatory marker levels after adjusting for STS risk score.…”

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

“…These molecular changes may persist for days or weeks after CABG 12. In particular, several studies have described marked and protracted activation of several molecular pathways, reflecting a systemic inflammatory reaction, platelet and coagulation activation, and increased oxidative stress and endothelial dysfunction 13.…”