title: Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting - a prospective randomized comparison of the conventional and three minimally invasive surgical techniques.
abstract: OBJECTIVE
  In order to evaluate the traumatic effects of median sternotomy and cardiopulmonary bypass (CPB) in conventional and minimally invasive coronary artery bypass grafting, inflammatory response was studied in a prospective randomized trial in patients referred to single-vessel coronary artery bypass grafting.
  
  
  METHODS
  Four surgical techniques were compared: group 1, median sternotomy with CPB in ten patients (eight male, two female; aged 59.6+/-11.0 years (mean+/-SD)); group 2, median sternotomy and off-pump in ten patients (seven male, three female; aged 65.1+/-10.0 years); group 3, minithoracotomy with CPB in ten patients (seven male, three female, aged 61.2+/-10.4 years); group 4, minithoracotomy and off-pump in ten patients (nine male, one female, aged 62.9+/-9.8 years). All patients received a left internal mammary artery graft to the left anterior descending artery (LAD). Clinical data, perioperative values of cytokines and cardiac enzymes were monitored.
  
  
  RESULTS
  There were no major complications. Troponin-T and creatine kinase isoenzyme MB (CK-MB) levels were significantly higher in CPB procedures (P<0.0056; multivariate general linear model). Interleukin-6 (IL-6) levels were significantly higher in minithoracotomy procedures. Interleukin-1 (IL-1) was significantly increased in all patients compared with the preoperative values.
  
  
  CONCLUSIONS
  The use of CPB is combined with higher levels of troponin-T and CK-MB as signs of myocardial damage. Surgical access was identified as a trigger of inflammatory response, as minithoracotomy is related to higher levels of IL-6. IL-1 increased in all procedures and this occurred independently of the surgical access or the use of CPB, which points out a potential relationship between inflammatory response and anesthesia. Neither CPB nor surgical access influenced the clinical outcome in the treatment of coronary artery single-vessel bypass grafting.
authors.affiliation: Cardiovascular Institute, University Hospital Dresden, Fetscherstrasse 76, 01307, Dresden, Germany. vassilios.gulielmos.hkz_dd@t-online.de
authors.forename: V
authors.initials: V
authors.lastname: Gulielmos
authors.forename: M
authors.initials: M
authors.lastname: Menschikowski
authors.forename: H
authors.initials: H
authors.lastname: Dill
authors.forename: M
authors.initials: M
authors.lastname: Eller
authors.forename: S
authors.initials: S
authors.lastname: Thiele
authors.forename: S M
authors.initials: SM
authors.lastname: Tugtekin
authors.forename: W
authors.initials: W
authors.lastname: Jaross
authors.forename: S
authors.initials: S
authors.lastname: Schueler
mesh_terms: D000368:Aged; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects* / Q000379:methods*; D007527:Isoenzymes / Q000097:blood*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D015999:Multivariate Analysis; D011446:Prospective Studies; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods*; D020107:Troponin T / Q000097:blood*
chemical_list: D007375:Interleukin-1; D015850:Interleukin-6; D007527:Isoenzymes; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form