Intermediate coronary revascularization using the Deltastream blood pump: results from an experimental study.
BACKGROUND
Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization.


METHODS
In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A). Seven other animals served as controls and underwent standard myocardial revascularization with the same device as integrated pump of a complete heart-lung machine (group B). Blood samples for blood gas metabolism, creatine kinase (CK), troponin I, lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH) were taken before and after the entire operation.


RESULTS
Comparing the baseline values, the increase of CK was more pronounced in group B than in group A (176.4-/+41.2 to 279.7-/+29 U/L vs. 274-/+142.7 to 288.1-/+118.6 U/L, respectively; p=0.0006). Increase of troponin I was significantly higher in group B than in group A (1-/+0.3 to 2.9-/+1 ng/mL vs. 1.1-/+0.9 to 3-/+3.8 ng/mL, respectively; p=0.002). LDH increase was also more pronounced in group B (231.7-/+54.3 to 299.9-/+39.8 U/L vs. 274.9-/+59.7 to 263.8-/+57.9 U/L, respectively; p=0.01). HBDH values increased significantly in group B after the operation (group A: 215.9-/+34.7 to 200-/+39.2 U/L vs. group B: 195.4-/+41.7 to 274.9-/+51.6 U/L; p=0.02). Hemodynamic measures and LDH values under luxation (group A: 1.9-/+0.6 U/L; B: 3.5-/+1 U/L,p=0.001) were also superior in the study group.


CONCLUSIONS
The current set-up might be superior to conventional extracorporeal circulation and thus be an alternative for high-risk candidates to avoid the adverse events of a complete heart-lung machine, when they are scheduled for complete myocardial revascularization.
Litmathe
J
J
Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Duesseldorf, Germany. jens-litmathe@t-online.de
Hansen
E
E
Feindt
P
P
Kurt
M
M
Boeken
U
U
Gams
E
E
D000818:Animals; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003402:Creatine Kinase / Q000097:blood; D004867:Equipment Design; D005240:Feasibility Studies; D006355:Heart-Lung Machine / Q000009:adverse effects; D006461:Hemolysis; D006884:Hydroxybutyrate Dehydrogenase / Q000097:blood; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008422:Materials Testing; D023421:Models, Animal; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013249:Sternum / Q000601:surgery; D013552:Swine; D013556:Swine, Miniature; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
D015415:Biomarkers; D019210:Troponin I; D007770:L-Lactate Dehydrogenase; D006884:Hydroxybutyrate Dehydrogenase; D003402:Creatine Kinase