Minimizing cardiopulmonary bypass attenuates myocardial damage after cardiac surgery.
The standard heart-lung machine is deemed a major trigger of systemic inflammatory reactions, potentially inducing organ failure. The strict reduction of blood-artificial surface and blood-air contact might represent meaningful improvements of the extracorporeal technology with respect to organ preservation. In this study, we assessed perioperative myocardial damage by using a novel minimal extracorporeal circuit (MECC) and a conventional cardiopulmonary bypass (CPB) system. Sixty patients scheduled for coronary artery bypass surgery were randomly assigned to either the MECC or the standard CPB system. Myocardial markers were determined by specific immunoassays 6, 12, and 24 hours after CPB initiation. Results were corrected for hemodilution.Demographics, hemodynamics, the number of anastomoses, CPB, and cross-clamp time were comparable between the groups. MECC patients demonstrated significantly lower levels of Troponin T (ng/ml) at 6, 12, and 24 hours (0.07 +/- 0.01 vs. 0.16 +/- 0.04, p < 0.005; 0.12 +/- 0.03 vs. 0.28 +/- 0.08, p < 0.008; 0.21 +/- 0.05 vs. 0.35 +/- 0.09, p < 0.03, respectively) and creatine kinase-MB (U/l) at 6 and 12 hours (22.5 +/- 1.5 vs. 40.6 +/- 3.3, p < 0.0001; 23.3 +/- 3.4 vs. 40.8 +/- 8.0, p < 0.001, respectively). Creatine kinase-MB at 24 hours tended to lower values in the MECC group but did not quite reach statistical significance. The MECC system may not only provide a less invasive solution to meet the requirements during cardiac surgery but also a more organ-preserving alternative to standard CPB.
Skrabal
Christian A
CA
University of Rostock, Department of Cardiac Surgery, Schillingallee 35, 18057 Rostock, Germany.
Steinhoff
Gustav
G
Liebold
Andreas
A
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood
D020107:Troponin T