Thorac Cardiovasc Surg 2010; 58 - V55
DOI: 10.1055/s-0029-1246697

Initial experience with circulating-endothelial-cells (CEC) as a supersensitive marker of tissue- damage in less-invasive-coronary-surgery: is minimal extracorporeal circulation (MEC) equivalent to OPCAB?

T Wittwer 1, YH Choi 1, K Neef 1, M Schink 1, A Sabashnikov 1, T Holst 1, J Strauch 1, J Wippermann 1, F Kuhn-Regnier 1, G Langebartels 1, P Teschendorf 2, O Mehler 2, T Wahlers 1
  • 1Herzzentrum der Universität zu Köln, Klinik für Herz- und Thoraxchirurgie, Köln, Germany
  • 2Universität zu Köln, Klinik für Anästhesiologie und Operative Intensivmedizin, Köln, Germany

Off-pump-coronary-artery-bypass-grafting (OPCAB) and use of minimal-extracorporeal-circulation-systems (MEC) have been proposed to avoid potentially harmful effects of full cardiopulmonary bypass (CPB). Circulating endothelial cells (CEC) are hypersensitive markers of tissue and endothelial damage and were shown to be significantly elevated in conventional-CPB-procedures as compared to MEC-revascularisation. Therefore, CEC are considered to be of specific interest in evaluation of effectiveness of MEC and OPCAB as currently applied less-invasive-coronary-procedures.

33 consecutive coronary patients were randomly assigned either to OPCAB (n=15) or to MEC (ROCsafe™, Terumo Inc., n=18) procedures. Perioperative data, clinical and serological outcome and serial measurements of CEC-release and parameters of endothelial function (v. Willebrand-Factor, soluble-thrombomodulin) perioperatively (pre-operative-baseline, post-MEC/release of OPCAB-stabilisator, 6h, 12h, 24h and 120h postoperatively) were obtained and compared by ANOVA models including repeated-measures-analysis.

Mean graft-number was 3±0.8 in MEC-patients and 1.6±0.7 in OPCAB-patients (p<0.01). However, ventilation-, ICU- and total hospital times were comparable between groups as were chest-tube-drainage, transfusion requirements, hemodynamics and catecholaminergic support (p>0.05). CEC-release was overall comparable but revealed a trend towards lower values 6h-postoperatively in MEC-patients (p=0.66), whereas Troponin-T-levels where generally lower in OPCAB-patients (p<0.05). No myocardial infarctions, strokes or deaths occurred, Neuron-specific-Enolase (NSE) was not significantly different between groups (p=0.46).

Conceptional advantages of closed-minimised-CPB-systema (ROCsafe™) result in morbidity and mortality comparable with OPCAB procedures. MEC therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, MEC combines OPCAB-benefits with less morbidity in high-risk-patients while facilitating more complete revascularisation in patients with complex lesions.