Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study

Formica, Francesco; Broccolo, Francesco; Martino, Antonello; Sciucchetti, Jennifer; Giordano, Vincenzo; Avalli, Leonello; Radaelli, Gianluigi; Ferro, Orazio; Corti, Fabrizio; Cocuzza, Clementina; Paolini, Giovanni

doi:10.1016/j.jtcvs.2008.09.074

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 5 , Pages 1206-1212, May 2009

Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study

Francesco Formica, MD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
- Address for reprints: Francesco Formica, MD, Clinica Cardiochirurgica, Ospedale San Gerardo, Via Pergolesi 33, 20052, Monza (MI) Italy.
Francesco Broccolo, MD
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
Antonello Martino, MD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
Jennifer Sciucchetti, MD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
Vincenzo Giordano, MD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
Leonello Avalli, MD
- Cardiac Surgery Intensive Care, San Gerardo Hospital, Monza, Italy
Gianluigi Radaelli, MD
- Cardiac Surgery Intensive Care, San Gerardo Hospital, Monza, Italy
Orazio Ferro, MD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
Fabrizio Corti, MD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
Clementina Cocuzza, MD, PhD
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
Giovanni Paolini, MD, PhD
- Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy

Received 26 February 2008; received in revised form 6 September 2008; accepted 19 September 2008. published online 23 February 2009.

Objective

This prospective randomized study sought to verify the systemic inflammatory response, inflammatory myocardial damage, and early clinical outcome in coronary surgery with the miniaturized extracorporeal circulation system or on the beating heart.

Methods

Sixty consecutive patients were randomized to miniaturized extracorporeal circulation (n = 30) or off-pump coronary revascularization (off-pump coronary artery bypass grafting, n = 30). Intraoperative and postoperative data were recorded. Plasma levels of interleukin-6 and tumor necrosis factor-α were measured from systemic blood intraoperatively, at the end of operation, and 24 and 48 hours thereafter. Levels of the same markers and blood lactate were measured from coronary sinus blood intraoperatively to evaluate myocardial inflammation. Markers of myocardial damage were also analyzed.

Results

One patient died in the off-pump coronary artery bypass grafting group. There was no statistical difference in early clinical outcome in both groups. Release of interleukin-6 was higher in the off-pump coronary artery bypass grafting group 24 hours after the operation (P = .03), whereas levels of tumor necrosis factor-α were not different in both groups. Cardiac release of interleukin-6, tumor necrosis factor-α, and blood lactate were not different in both groups. Release of troponin T was not significantly different in both groups. Levels of creatine kinase mass were statistically higher in the miniaturized extracorporeal circulation group than in the off-pump coronary artery bypass grafting group, but only at the end of the operation (P < .0001). Hemoglobin levels were significantly higher in the miniaturized extracorporeal circulation group than in the off-pump coronary artery bypass grafting group after 24 hours (P = .01).

Conclusion

Miniaturized extracorporeal circulation can be considered similar to off-pump surgery in terms of systemic inflammatory response, myocardial inflammation and damage, and early outcome.

CTSNet classification: 23, 25

Abbreviations and Acronyms: CK, creatine kinase, CPB, cardiopulmonary bypass, CS, coronary sinus, IL, interleukin, MECC, miniaturized extracorporeal circulation, OPCABG, off-pump coronary artery bypass grafting, SIRS, systemic inflammation response syndrome, TNF, tumor necrosis factor, TnT, troponin T