title: Systemic and myocardial inflammatory response in coronary artery bypass graft surgery with miniaturized extracorporeal circulation: differences with a standard circuit and off-pump technique in a randomized clinical trial.
abstract: Inflammatory response and hemodilution are the main drawbacks of extracorporeal circulation. We hypothesize that the use of miniaturized extracorporeal circulation (MECC) might lower the systemic and myocardial inflammatory patterns compared with a standard system (SECC) and off-pump coronary artery bypass grafting (OPCABG). Sixty-one patients undergoing isolated coronary artery bypass graft were prospectively randomized to MECC (n = 19), SECC (n = 20), or OPCABG (n = 22). Blood samples were collected from radial artery and coronary sinus to analyze blood lactate, hemodilution, and markers for inflammation and endothelial activation such as tumor necrosis factor (TNF)-α, interleukin-6, monocyte chemotactic protein-1, and E-selectin. No differences were observed in early clinical outcome. Interleukin -6 levels increased in every group during and after cardiac surgery, whereas TNF-α values grew in the SECC group (p = 0.05). E-selectin systemic values decreased during and after operation (p = 0.001) in every group. Monocyte chemotactic protein-1 systemic and cardiac levels raised only in SECC group (p = 0.014). In conclusion, MECC is comparable to SECC and OPCABG in the clinical outcome of low-risk patients, and it might be extensively used with no additional intraoperative risk. The analysis of the inflammatory patterns of endothelial activation shows MECC as effective as OPCABG, suggesting further studies to clarify MECC recommendation in high-risk patients.
authors.affiliation: From the *Cardiac Surgery Clinic, Department of Surgical Science and Interdisciplinary Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy; †Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy; ‡Cardiac Surgery Perfusion Service, San Gerardo Hospital, Monza, Italy; and §Cardiothoracic and Vascular Anaesthesia Intensive Care Unit, San Gerardo Hospital, Monza, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Formica
authors.forename: Silvia
authors.initials: S
authors.lastname: Mariani
authors.forename: Francesco
authors.initials: F
authors.lastname: Broccolo
authors.forename: Rosa
authors.initials: R
authors.lastname: Caruso
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Corti
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Alessandro
authors.forename: Pietro
authors.initials: P
authors.lastname: Amigoni
authors.forename: Fabio
authors.initials: F
authors.lastname: Sangalli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paolini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000209:etiology