On-pump coronary surgery with and without cardioplegic arrest: comparison of inflammation, myocardial, cerebral and renal injury and early and late health outcome in a single-centre randomised controlled trial.
OBJECTIVE
To assess the safety and efficacy of on-pump beating heart coronary surgery on organ function, and early and late health outcome as compared with conventional technique.


METHODS
A total of 81 patients were randomised to (1) coronary surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) (on-pump with CA, n=41) or to (2) CPB without CA (on-pump without CA, n=40). Primary outcomes included serial measurement of interleukins (IL-6, IL-8 and IL-10) for inflammation, troponin I for myocardial injury, protein S100 for cerebral injury and creatinine clearance (CrCl) and urinary N-acetyl-β-d-glucosaminidase (NAG) for renal injury. In-hospital health outcome and 5-year event-free survival were secondary outcomes.


RESULTS
Baseline and intra-operative characteristics were similar between groups. A marked release of ILs was observed in both groups, but no significant differences between the groups were found (IL-6 +9%, 95% confidence interval (CI) -15% to +39%, p=0.49; IL-8 +4%, 95% CI -34% to +63%, p=0.86; IL-10 -0.1%, 95% CI -19% to +21%, p=0.93). Troponin I rose in both groups and was on average 34% higher in the on-pump without CA group but this did not reach statistical significance (95% CI -0.4% to +87%, p=0.08). S100 protein was higher in the on-pump without CA group at 12h (p=0.04) but did not differ at other times (p=0.16). The level of CrCl was higher 1h in the on-pump without CA group (+23%, 95% CI +1% to +50%, p=0.04), but not thereafter. NAG release was similar in both groups (+1% 95% CI -23% to +33%, p=0.91). Early and 5-year health outcomes were similar.


CONCLUSIONS
On-pump without CA coronary surgery does not provide any obvious advantage when compared with the conventional technique of on-pump with CA in elective patients. Both techniques provide a comparable degree of inflammatory activation, myocardial, cerebral and renal injury with similar 5-year event-free survival.
Narayan
Pradeep
P
Bristol Heart Institute, University of Bristol, Bristol, UK.
Rogers
Chris A
CA
Bayliss
Kate M
KM
Rahaman
Natasha C
NC
Panayiotou
Nayia
N
Angelini
Gianni D
GD
Ascione
Raimondo
R
D000118:Acetylglucosaminidase / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000209:etiology; D009202:Cardiomyopathies / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation / Q000209:etiology; D018836:Inflammation Mediators / Q000097:blood; D007378:Interleukins / Q000097:blood; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009418:S100 Proteins / Q000097:blood; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D018836:Inflammation Mediators; D007378:Interleukins; D009418:S100 Proteins; D019210:Troponin I; D003404:Creatinine; D000118:Acetylglucosaminidase