Abstract
BackgroundOff-pump-coronary-artery-bypass-grafting (OPCAB) and minimized-extracorporeal-circulation (Mini-HLM) have been proposed to avoid harmful effects of cardiopulmonary-bypass (CPB). Controversies exist whether OPCAB is still superior in perioperative outcome. Circulating endothelial cells (CEC) are sensitive markers of endothelial damage and are significantly elevated in conventional-CPB-procedures as compared to Mini-HLM-revascularisation. Therefore, CEC might be of specific value in evaluating effectiveness of Mini-HLM and OPCAB as currently applied less-invasive coronary procedures.Methods76 coronary patients were randomly assigned either to OPCAB (n = 34) or to Mini-HLM (ROCsafe™, Terumo Inc., n = 42) procedures. Perioperative data, clinical and serological outcome and measurements of CEC-release and parameters of endothelial function (v.Willebrand-Factor, soluble-thrombomodulin) perioperatively (pre-operative-baseline, post-Mini-HLM/release of OPCAB-stabilizer, 6 h, 12 h, 24 h and 5 days postoperatively) were obtained and compared by ANOVA models including repeated-measures-analysis.ResultsMean graft-number was 3.06 ± 0.72 in Mini-HLM-patients and 1.89 ± 0.74 in OPCAB-patients (p < 0.001). However, ventilation-, ICU- and total-hospital duration were comparable between groups as well as chest-tube-drainage, transfusion requirements, hemodynamics and catecholaminergic support (p > 0.05). CEC-release did not differ between groups (p = 0.274) and was generally within normal limits, Troponin-T levels where not significanty different (p = 0.108). No myocardial infarctions, strokes or deaths occurred, neuron specific enolase (NSE) did not show any differences between groups (p = 0.194).ConclusionConceptional advantages of minimized CPB systems (ROCsafe™) result in morbidity and mortality comparable with OPCAB procedures. Mini-HLM therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity in high-risk patients while facilitating more complete revascularization in complex patients.
Highlights
For decades coronary artery bypass grafting (CABG) was performed with the use of conventional cardiopulmonary bypass (CCPB)
In order to decrease morbidity and mortality associated with coronary surgery, myocardial revascularization without CCPB has been introduced into clinical practice in terms of the off-pump coronary artery bypass grafting (OPCAB) procedure [2]
One major mechanism of the beneficial effect of MiniHLM is considered to be the lesser degree of endothelial injury which can be assessed by quantification of Circulating Endothelial Cells (CEC) which represent a novel marker of the intrinsic endothelial damage caused by cardiopulmonary bypass [11]
Summary
For decades coronary artery bypass grafting (CABG) was performed with the use of conventional cardiopulmonary bypass (CCPB). In order to decrease morbidity and mortality associated with coronary surgery, myocardial revascularization without CCPB has been introduced into clinical practice in terms of the off-pump coronary artery bypass grafting (OPCAB) procedure [2]. As a consequence, minimized extracorporeal circulation systems (Mini-HLM) have been proposed to avoid the potentially harmful effects of CCPB. One major mechanism of the beneficial effect of MiniHLM is considered to be the lesser degree of endothelial injury which can be assessed by quantification of Circulating Endothelial Cells (CEC) which represent a novel marker of the intrinsic endothelial damage caused by cardiopulmonary bypass [11]. Off-pump-coronary-artery-bypass-grafting (OPCAB) and minimized-extracorporeal-circulation (MiniHLM) have been proposed to avoid harmful effects of cardiopulmonary-bypass (CPB). Circulating endothelial cells (CEC) are sensitive markers of endothelial damage and are significantly elevated in conventional-CPB-procedures as compared to Mini-HLMrevascularisation. CEC might be of specific value in evaluating effectiveness of Mini-HLM and OPCAB as currently applied less-invasive coronary procedures
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
