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DOI: 10.1055/s-0034-1367084
Quantification of circulating endothelial cells and perioperative outcome in less invasive coronary surgery: Are Off-pump procedures superior than minimized extracorporeal circulation?
Objective: Off-pump-coronary-artery-bypass-grafting (OPCAB) and use of minimal-extracorporeal-circulation-systems (MiniHLM) have been proposed to avoid potentially harmful effects of full cardiopulmonary bypass (CPB). Circulating endothelial cells (CEC) are sensitive markers of tissue and endothelial damage and were shown to be significantly elevated in conventional-CPB-procedures as compared to MiniHLM-revascularisation. Therefore, CEC are considered to be of specific interest in evaluation of effectiveness of MiniHLM and OPCAB as currently applied less-invasive-coronary-procedures.
Methods: 120 consecutive coronary patients were randomly assigned either to OPCAB (n = 44) or to MiniHLM (n = 76) 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-MiniHLM/release of OPCAB-stabilisator, 6 h, 12 h, 24 h and 120 h postoperatively) were obtained and compared by ANOVA models including repeated-measures-analysis.
Results: Generally, 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 between groups and did not show any significant increase over time, accordingly Troponin-levels where generally not significantly different (p = 0.108). Anatomically complete revascularisation was achieved in all cases, however, mean graft-number was 3,12 ± 0,7 in MiniHLM-patients and 1,85 ± 0,7 in OPCAB-patients (p = 0.001). No myocardial infarctions, strokes or deaths occurred, Neuron-specific-Enolase was not significantly different between groups (p = 0.46).
Conclusion: Conceptional advantages of closed-minimised-CPB-systems (ROCsafe™) result in morbidity and mortality comparable with OPCAB procedures. MiniHLM therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, MiniHLM achieves all clinical OPCAB-benefits but may allow for less demanding revascularisation than OPCAB in special patients with complex coronary anatomy and can therefore be used both on a routine basis and in all “conversion“ cases of OPCAB.