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J Thorac Cardiovasc Surg 2009;137:1206-1212
© 2009 The American Association for Thoracic Surgery

Cardiopulmonary Support

Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study

Francesco Formica, MDa,*, Francesco Broccolo, MDb, Antonello Martino, MDa, Jennifer Sciucchetti, MDa, Vincenzo Giordano, MDa, Leonello Avalli, MDc, Gianluigi Radaelli, MDc, Orazio Ferro, MDa, Fabrizio Corti, MDa, Clementina Cocuzza, MD, PhDb, Giovanni Paolini, MD, PhDa

a Cardiac Surgery Clinic, Department of Surgical Science, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
b Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
c Cardiac Surgery Intensive Care, San Gerardo Hospital, Monza, Italy

Received for publication February 26, 2008; revisions received September 6, 2008; accepted for publication September 19, 2008.

* Address for reprints: Francesco Formica, MD, Clinica Cardiochirurgica, Ospedale San Gerardo, Via Pergolesi 33, 20052, Monza (MI) Italy. (Email: francesco_formica{at}fastwebnet.it).

Objective: This prospective randomized study sought to verify the systemic inflammatory response, inflammatory myocardial damage, and early clinical outcome in coronary surgery with the miniaturized extracorporeal circulation system or on the beating heart.

Methods: Sixty consecutive patients were randomized to miniaturized extracorporeal circulation (n = 30) or off-pump coronary revascularization (off-pump coronary artery bypass grafting, n = 30). Intraoperative and postoperative data were recorded. Plasma levels of interleukin-6 and tumor necrosis factor-{alpha} were measured from systemic blood intraoperatively, at the end of operation, and 24 and 48 hours thereafter. Levels of the same markers and blood lactate were measured from coronary sinus blood intraoperatively to evaluate myocardial inflammation. Markers of myocardial damage were also analyzed.

Results: One patient died in the off-pump coronary artery bypass grafting group. There was no statistical difference in early clinical outcome in both groups. Release of interleukin-6 was higher in the off-pump coronary artery bypass grafting group 24 hours after the operation (P = .03), whereas levels of tumor necrosis factor-{alpha} were not different in both groups. Cardiac release of interleukin-6, tumor necrosis factor-{alpha}, and blood lactate were not different in both groups. Release of troponin T was not significantly different in both groups. Levels of creatine kinase mass were statistically higher in the miniaturized extracorporeal circulation group than in the off-pump coronary artery bypass grafting group, but only at the end of the operation (P < .0001). Hemoglobin levels were significantly higher in the miniaturized extracorporeal circulation group than in the off-pump coronary artery bypass grafting group after 24 hours (P = .01).

Conclusion: Miniaturized extracorporeal circulation can be considered similar to off-pump surgery in terms of systemic inflammatory response, myocardial inflammation and damage, and early outcome.

Abbreviations and Acronyms CK = creatine kinase; CPB = cardiopulmonary bypass; CS = coronary sinus; IL = interleukin; MECC = miniaturized extracorporeal circulation; OPCABG = off-pump coronary artery bypass grafting; SIRS = systemic inflammation response syndrome; TNF = tumor necrosis factor; TnT = troponin T


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