Systemic and Myocardial Inflammatory Response in Coronary Artery Bypass Graft Surgery With Miniaturized Extracorporeal Circulation: Differences With a Standard Circuit and Off-Pump Technique in a Randomized Clinical Trial

被引:22
|
作者
Formica, Francesco [1 ]
Mariani, Silvia [1 ]
Broccolo, Francesco [2 ]
Caruso, Rosa [3 ]
Corti, Fabrizio [1 ]
D'Alessandro, Stefano [1 ]
Amigoni, Pietro [1 ]
Sangalli, Fabio [4 ]
Paolini, Giovanni [1 ]
机构
[1] Univ Milano Bicocca, San Gerardo Hosp, Dept Surg Sci & Interdisciplinary Med, Cardiac Surg Clin, Monza, Italy
[2] Univ Milano Bicocca, Dept Clin Med & Prevent, Milan, Italy
[3] San Gerardo Hosp, Cardiac Surg Perfus Serv, Monza, Italy
[4] San Gerardo Hosp, Cardiothorac & Vasc Anaesthesia Intens Care Unit, Monza, Italy
关键词
cardiopulmonary bypass; miniaturized extracorporeal circulation; coronary artery bypass grafts; cytokines; inflammation; CARDIOPULMONARY BYPASS; ENDOTHELIAL DAMAGE; REVASCULARIZATION; COAGULATION; EXPRESSION; REDUCTION; MCP-1; CABG;
D O I
10.1097/MAT.0b013e3182a817aa
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
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)-, 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- 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.
引用
收藏
页码:600 / 606
页数:7
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