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Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study.
J Thorac Cardiovasc Surg. 2009 May; 137(5):1206-12.JT

Abstract

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-alpha 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-alpha were not different in both groups. Cardiac release of interleukin-6, tumor necrosis factor-alpha, 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.

Authors+Show Affiliations

Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy. francesco_formica@fastwebnet.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19379993

Citation

Formica, Francesco, et al. "Myocardial Revascularization With Miniaturized Extracorporeal Circulation Versus Off Pump: Evaluation of Systemic and Myocardial Inflammatory Response in a Prospective Randomized Study." The Journal of Thoracic and Cardiovascular Surgery, vol. 137, no. 5, 2009, pp. 1206-12.
Formica F, Broccolo F, Martino A, et al. Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg. 2009;137(5):1206-12.
Formica, F., Broccolo, F., Martino, A., Sciucchetti, J., Giordano, V., Avalli, L., Radaelli, G., Ferro, O., Corti, F., Cocuzza, C., & Paolini, G. (2009). Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study. The Journal of Thoracic and Cardiovascular Surgery, 137(5), 1206-12. https://doi.org/10.1016/j.jtcvs.2008.09.074
Formica F, et al. Myocardial Revascularization With Miniaturized Extracorporeal Circulation Versus Off Pump: Evaluation of Systemic and Myocardial Inflammatory Response in a Prospective Randomized Study. J Thorac Cardiovasc Surg. 2009;137(5):1206-12. PubMed PMID: 19379993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study. AU - Formica,Francesco, AU - Broccolo,Francesco, AU - Martino,Antonello, AU - Sciucchetti,Jennifer, AU - Giordano,Vincenzo, AU - Avalli,Leonello, AU - Radaelli,Gianluigi, AU - Ferro,Orazio, AU - Corti,Fabrizio, AU - Cocuzza,Clementina, AU - Paolini,Giovanni, Y1 - 2009/02/23/ PY - 2008/02/26/received PY - 2008/09/06/revised PY - 2008/09/19/accepted PY - 2009/4/22/entrez PY - 2009/4/22/pubmed PY - 2009/5/22/medline SP - 1206 EP - 12 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 137 IS - 5 N2 - 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-alpha 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-alpha were not different in both groups. Cardiac release of interleukin-6, tumor necrosis factor-alpha, 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. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/19379993/Myocardial_revascularization_with_miniaturized_extracorporeal_circulation_versus_off_pump:_Evaluation_of_systemic_and_myocardial_inflammatory_response_in_a_prospective_randomized_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(08)01872-2 DB - PRIME DP - Unbound Medicine ER -