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Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study.
J Thorac Cardiovasc Surg. 2004 Jun; 127(6):1624-31.JT

Abstract

OBJECTIVE

On-pump beating heart coronary artery surgery provides the opportunity to examine the isolated effect of cardiopulmonary bypass. This prospective randomized study compares the early clinical outcomes and inflammatory response of patients undergoing elective on-pump and off-pump beating heart coronary artery bypass grafting.

METHOD AND PATIENTS

Thirty-seven consecutive patients undergoing elective coronary artery bypass grafting were recruited from a pool of 73 patients, with 19 patients randomized to on-pump beating heart surgery and 18 patients to off-pump coronary bypass surgery. Intraoperative events and postoperative outcomes were recorded. Plasma levels of interleukin-6, interleukin-8, and interleukin-10, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 were measured before the operation, intraoperatively, after the operation, and 4, 24, and 48 hours thereafter.

RESULTS

There was no significant difference in clinical outcomes between the 2 groups. The operating time was longer and consumption of platelets was greater for the on-pump beating heart group. There was no postoperative mortality or major complication in either group. There was significant elevation in the levels of interleukin-6, interleukin-8, and interleukin-10 and tumor necrosis factor-alpha during and immediately after the operations in the on-pump beating heart group when compared with the off-pump group. Levels of interleukin-8 (P =.01) and tumor necrosis factor-alpha (P =.0004) remained significantly elevated 4 hours after the operation in the on-pump beating heart group. The level of vascular adhesion molecule dropped significantly during the operation but was elevated 4 hours (P =.026) after the operation in the on-pump beating heart group.

CONCLUSION

The use of cardiopulmonary bypass alone without global myocardial ischemia secondary to aortic crossclamping and cardioplegic cardiac arrest can trigger intense inflammatory responses.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15173716

Citation

Wan, Innes Y P., et al. "Beating Heart Revascularization With or Without Cardiopulmonary Bypass: Evaluation of Inflammatory Response in a Prospective Randomized Study." The Journal of Thoracic and Cardiovascular Surgery, vol. 127, no. 6, 2004, pp. 1624-31.
Wan IY, Arifi AA, Wan S, et al. Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg. 2004;127(6):1624-31.
Wan, I. Y., Arifi, A. A., Wan, S., Yip, J. H., Sihoe, A. D., Thung, K. H., Wong, E. M., & Yim, A. P. (2004). Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study. The Journal of Thoracic and Cardiovascular Surgery, 127(6), 1624-31.
Wan IY, et al. Beating Heart Revascularization With or Without Cardiopulmonary Bypass: Evaluation of Inflammatory Response in a Prospective Randomized Study. J Thorac Cardiovasc Surg. 2004;127(6):1624-31. PubMed PMID: 15173716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study. AU - Wan,Innes Y P, AU - Arifi,Ahmed A, AU - Wan,Song, AU - Yip,Johnson H Y, AU - Sihoe,Alan D L, AU - Thung,K H, AU - Wong,Eric M C, AU - Yim,Anthony P C, PY - 2004/6/3/pubmed PY - 2004/7/14/medline PY - 2004/6/3/entrez SP - 1624 EP - 31 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 127 IS - 6 N2 - OBJECTIVE: On-pump beating heart coronary artery surgery provides the opportunity to examine the isolated effect of cardiopulmonary bypass. This prospective randomized study compares the early clinical outcomes and inflammatory response of patients undergoing elective on-pump and off-pump beating heart coronary artery bypass grafting. METHOD AND PATIENTS: Thirty-seven consecutive patients undergoing elective coronary artery bypass grafting were recruited from a pool of 73 patients, with 19 patients randomized to on-pump beating heart surgery and 18 patients to off-pump coronary bypass surgery. Intraoperative events and postoperative outcomes were recorded. Plasma levels of interleukin-6, interleukin-8, and interleukin-10, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 were measured before the operation, intraoperatively, after the operation, and 4, 24, and 48 hours thereafter. RESULTS: There was no significant difference in clinical outcomes between the 2 groups. The operating time was longer and consumption of platelets was greater for the on-pump beating heart group. There was no postoperative mortality or major complication in either group. There was significant elevation in the levels of interleukin-6, interleukin-8, and interleukin-10 and tumor necrosis factor-alpha during and immediately after the operations in the on-pump beating heart group when compared with the off-pump group. Levels of interleukin-8 (P =.01) and tumor necrosis factor-alpha (P =.0004) remained significantly elevated 4 hours after the operation in the on-pump beating heart group. The level of vascular adhesion molecule dropped significantly during the operation but was elevated 4 hours (P =.026) after the operation in the on-pump beating heart group. CONCLUSION: The use of cardiopulmonary bypass alone without global myocardial ischemia secondary to aortic crossclamping and cardioplegic cardiac arrest can trigger intense inflammatory responses. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/15173716/Beating_heart_revascularization_with_or_without_cardiopulmonary_bypass:_evaluation_of_inflammatory_response_in_a_prospective_randomized_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022522303018877 DB - PRIME DP - Unbound Medicine ER -