No clear clinical benefit of using mini-invasive extracorporeal circulation in coronary artery bypass grafting in low-risk patients.
BACKGROUND
Current research is engaged in innovative technologies of extracorporeal circulation (ECC) systems in an effort to eliminate negative effects. Some studies have shown that, due to the complexity of technical settings of mini-ECC, they invoke a weaker immune response compared to classic ECC. The clinical benefits of using these systems have not been clearly proven yet.


METHODS
A group of 54 patients who were indicated for elective coronary surgery were randomised into two groups - Group A (patients operated on using classic ECC - open modification) and Group B (patients operated on using mini-ECC). The concentrations of IL-6, PMN elastase and MCP-1 in both groups were monitored per- and postoperatively, along with the postoperative clinical course.


RESULTS
The groups did not differ in the basic pre- and peroperative characteristics. We recorded a lower priming for mini-ECC (p < 0.001) and significantly reduced hemodilution during ECC. There were no differences in the clinical outcome in either group. Serum concentrations of monitored markers of immune reaction towards ECC showed higher activity during standard ECC.


CONCLUSIONS
New technologies used in mini-systems have proven to lower activation of the immune system, which can be monitored using kinetics of proinflammatory mediators. In spite of these comparable laboratory results, we did not find differences in short-term clinical results when comparing both these groups of low-risk patients.
Svitek
Vladimir
V
Department of Cardiac Surgery of Charles University in Prague, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec Kralove, Czech Republic. vladimirsvitek@centrum.cz
Lonsky
Vladimir
V
Mandak
Jiri
J
Krejsek
Jan
J
Kolackova
Martina
M
Brzek
Vladimir
V
Kubicek
Jaroslav
J
Volt
Martin
M
Bartos
Michael
M
Harrer
Jan
J
D000368:Aged; D018932:Chemokine CCL2 / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged
D018932:Chemokine CCL2; D015850:Interleukin-6; D019272:Leukocyte Elastase