Mini-extracorporeal circulation surgery produces less inflammation than off-pump coronary surgery
Por:
Permanyer, E, Munoz-Guijosa, C, Padro, JM, Ginel, A, Montiel, J, Sanchez-Quesada, JL, Vila, L, Camacho, M
Publicada:
1 mar 2020
Resumen:
OBJECTIVES: Both off-pump coronary artery bypass grafting surgery (OPCABG) and mini-extracorporeal circulation (MECC) have been associated with lower morbidity and mortality and less inflammation than conventional cardiopulmonary bypass. However, studies comparing the 2 techniques are scarce and the results are controversial. We compared the clinical outcomes and inflammatory response of low-risk patients undergoing coronary bypass grafting with MECC versus OPCABG.
METHODS: We conducted a prospective, randomized study in patients undergoing coronary heart surgery. Two hundred and thirty consecutive low-risk patients were randomly assigned to either receive OPCABG (n=117) or MECC (n=113). Clinical outcomes and postoperative biochemical results were analysed in both groups. We also analysed 19 circulating inflammatory markers in a subgroup of 40 patients at 4 perioperative time points. The area under the curve for each marker was calculated to monitor differences in the inflammatory response.
RESULTS: No significant differences were found between groups regarding perioperative clinical complications and no deaths occurred during the trial. Plasma levels in 9 of the 19 inflammatory markers were undetectable or showed no temporal variation, 3 were higher in the MECC group [interleukin (IL)-10, macrophage inflammatory protein-1 beta and epidermal growth factor] and 7 were higher in the OPCABG group (growth regulator oncogene, IL-6, IL-8, soluble CD40 ligand, monocyte chemoattractant protein-1, monocyte chemoattractant protein-3 and tumour necrosis factor-alpha). Differences in 2 proinflammatory cytokines, IL-6 and monocyte chemoattractant protein 1, between the 2 surgical procedures were statistically significant.
CONCLUSIONS: No clinical differences were observed between in low-risk patients undergoing MECC or OPCABG surgery, but OPCABG was associated with an increased release of proinflammatory cytokines compared with MECC. Studies in larger cohorts and in patients at higher risk are needed to confirm these findings.
Filiaciones:
Permanyer, E:
Quironsalud Teknon Heart Inst, Dept Cardiac Surg, C Vilana 12, Barcelona 08022, Spain
IIB St Pau, Res Inst Hosp St Pau, Dept Cardiac Surg, Hosp Santa Creu & St Pau, Barcelona, Spain
Munoz-Guijosa, C:
Univ Hosp Germans Trias I Pujol, Dept Cardiac Surg, Badalona, Spain
Padro, JM:
IIB St Pau, Res Inst Hosp St Pau, Dept Cardiac Surg, Hosp Santa Creu & St Pau, Barcelona, Spain
Ginel, A:
IIB St Pau, Res Inst Hosp St Pau, Dept Cardiac Surg, Hosp Santa Creu & St Pau, Barcelona, Spain
Montiel, J:
IIB St Pau, Res Inst Hosp St Pau, Dept Cardiac Surg, Hosp Santa Creu & St Pau, Barcelona, Spain
Sanchez-Quesada, JL:
IIB St Pau, Res Inst Hosp St Pau, CIBERDEM, Cardiovasc Res Grp, Barcelona, Spain
Vila, L:
IIB St Pau, Lab Angiol Vasc Biol & Inflammat, Res Inst Hosp St Pau, Barcelona, Spain
Camacho, M:
IIB St Pau, Lab Angiol Vasc Biol & Inflammat, Res Inst Hosp St Pau, Barcelona, Spain
IIB St Pau, Res Inst Hosp St Pau, Genom Complex Dis, Barcelona, Spain
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