Myocardial revascularization by left ventricular assisted beating heart is associated with reduced systemic inflammatory response.
BACKGROUND
The present study was designed to investigate whether use of left ventricular assisted technique (LVA) in beating-heart myocardial revascularization would exert less impact on patients' inflammatory response, as compared with minimal extracorporeal circulation (MECC).


METHODS
Seventy-three consecutive high-risk patients undergoing myocardial revascularization were randomly assigned either to LVA (group A) or to MECC (group B). Monocyte count and plasma concentration of C-reactive protein, inflammatory cytokines interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha, and polymorphonuclear elastase were measured at baseline and at various time points postoperatively.


RESULTS
Preoperative clinical and demographic data did not differ between the two groups. The two groups also were similar with respect to mortality, number of grafts performed, duration of extracorporeal circulation, and need for inotropes. However, LVA was associated with significantly less inflammatory response postoperatively compared with MECC, as indicated by a significant difference in interleukin-6 (p = 0.002), C-reactive protein (p = 0.002), monocyte percentage (p = 0.006), tumor necrosis factor-alpha (p = 0.002), and polymorphonuclear elastase (p = 0.001).


CONCLUSIONS
High-risk patients undergoing beating-heart myocardial revascularization with LVA show reduced inflammatory response compared with patients treated with the MECC.
Stassano
Paolo
P
Cardiac Surgery Unit, School of Medicine, University Federico II, Naples, Italy.
Di Tommaso
Luigi
L
Monaco
Mario
M
Iesu
Severino
S
Brando
Giancarlo
G
Buonpane
Salvatore
S
Ambrosio
Giuseppe
G
Di Benedetto
Giuseppe
G
Pepino
Paolo
P
D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism*; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery; D016207:Cytokines / Q000032:analysis / Q000378:metabolism; D017558:Elective Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D018836:Inflammation Mediators / Q000032:analysis*; D015850:Interleukin-6 / Q000032:analysis / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011336:Probability; D011859:Radiography; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000378:metabolism
D016207:Cytokines; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein