Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial.
BACKGROUND
Right ventricular assist devices (RVADs) have been proposed to improve exposure of the coronary arteries in off-pump surgery. In this study we investigated the impact of the A-Med RVAD on inflammatory response and organ function in patients undergoing coronary artery bypass grafting.


METHODS
Sixty patients were prospectively randomized to conventional surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest, beating heart surgery (off-pump), or beating heart surgery with the RVAD. Serial blood samples were collected postoperatively, for analysis of inflammatory markers, troponin I, protein S100, and free hemoglobin. Renal tubular function was assessed by measuring urine N-acetyl-glucosaminidase activity.


RESULTS
No hospital deaths or major postoperative complications occurred in the study population. Interleukin-6, interleukin-8, C3a, and troponin I levels after surgery were significantly higher in the CPB group compared with the off-pump and RVAD groups. Free hemoglobin levels immediately after the operation, peak and total S100 levels, and N-acetyl-glucosaminidase activity were also significantly higher in the CPB group.


CONCLUSIONS
Off-pump coronary revascularization, with or without RVAD, reduces inflammatory response, myocardial, neurologic, and renal injury, and decreases hemolysis when compared with conventional surgery with CPB and cardioplegic arrest.
Caputo
Massimo
M
Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom.
Yeatman
Mark
M
Narayan
Pradeep
P
Marchetto
Giovanni
G
Ascione
Raimondo
R
Reeves
Barnaby C
BC
Angelini
Gianni D
GD
D000118:Acetylglucosaminidase / Q000652:urine; D002315:Cardiopulmonary Bypass; D015926:Complement C3a / Q000032:analysis; D001026:Coronary Artery Bypass / Q000379:methods*; D006321:Heart / Q000503:physiopathology; D006324:Heart Arrest, Induced; D006353:Heart-Assist Devices; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D009420:Nervous System / Q000503:physiopathology; D011446:Prospective Studies; D017293:Protein S / Q000032:analysis; D019210:Troponin I / Q000097:blood
D006454:Hemoglobins; D015850:Interleukin-6; D016209:Interleukin-8; D017293:Protein S; D019210:Troponin I; D015926:Complement C3a; D000118:Acetylglucosaminidase