Background
We investigated whether the use of left ventricular-assisted (LVA) technique in beating
heart myocardial revascularization would exert less impact on patients adhesion molecules
and oxygenation index as compared with conventional cardiopulmonary bypass (CPB).
Methods
Sixty-six consecutive patients undergoing myocardial revascularization were randomly
assigned either to LVA (group A, 34 patients) or CPB (group B, 32 patients). Adhesion
molecules and oxygenation indexes were measured at baseline and at various time points
postoperatively.
Results
Pre-operative clinical and demographic data did not differ between the 2 groups. The
2 groups were also similar with respect to mortality, number of grafts performed,
duration of extracorporeal circulation, and need for inotropes. However, postoperatively
patients treated with LVA had a reduced levels of adhesion molecules compared with
patients treated with CPB, as indicated by a significant difference in endothelial
leukocyte adhesion molecule-1 (P = .002), intercellullar adhesion molecule-1 (P = .0001), and vascular cell adhesion molecule-1 (P = .004). The oxygenation index at 1 (P = .04) and 3 hours (P = .03) postoperatively was better in the LVA group than in the CPB group.
Conclusion
Patients undergoing beating heart myocardial revascularization with LVA show reduced
levels of adhesion molecules and better oxygenation index than patients treated with
CPB.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related qualità of life: long-term follow-up of 2 randomized controlled trials.J Thorac Cardiovasc Surg. 2009; 137: 295-303
- Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules.Ann Thorac Surg. 1998; 66: 2135-2144
- Expression of adhesion molecules and cytokines after coronary artery bypass grafting during normothermic and hypothermic cardiac arrest.Eur J Cardio-thorac Surg. 2000; 17: 723-728
- Myocardial revascularization by left ventricular assisted beating heart is associated with reduced systemic inflammatory response.Ann Thorac Surg. 2009; 87: 46-52
- ACC/AHA 2004 guideline update for coronary artery bypass graft surgery.Circulation. 2004; 110: 340-347
- Left heart pump-assisted beating heart coronary surgery in the high risk patients.Asian Cardiovasc Thorac Ann. 2008; 16: 159-161
- Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update.Eur J Cardio-thorac Surg. 2002; 21: 232-244
- Are circulating adhesion molecules specifically changed in cardiac surgical patients?.Ann Thorac Surg. 1998; 65: 608-614
- Endothelial cell injury in cardiac surgery: salicylate may be protective by reducing expression of endothelial adhesion molecules.Eur J Cardio-thorac Surg. 1998; 13: 293-297
- Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass.Ann Thorac Surg. 2001; 72: 1316-1320
- Complement inhibition with soluble complement receptor type 1 in cardiopulmonary bypass.Ann Thorac Surg. 1993; 55: 619-624
- Simvastatin blunts the increase of circulating adhesion molecules after coronary artery bypass surgery with cardiopulmonary bypass.J Cardiothorac Vasc An. 2004; 18: 605-609
- Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults.Eur J Cardio-thorac Surg. 2000; 17: 77-83
- Adhesion molecules and their role in vascular disease.Am J Hypertension. 2001; 14: 445-455
- Soluble adhesion molecules in reperfusion during coronary bypass grafting.Eur J Cardio-thorac Surg. 1998; 14: 290-295
- Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study.J Thorac Cardiovasc Surg. 2004; 127: 1624-1631
- Pulmonary dysfunction after cardiac surgery.Chest. 2002; 121: 1269-1277
- Ventilation during cardiopulmonary bypass: impact on cytokines response and cardiopulmonary function.Ann Thorac Surg. 2008; 85: 154-162
- Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial.Ann Thorac Surg. 1999; 67: 994-1000
- Pneumoproteins as lung-specific biomarker of alveolar permeability in conventional on-pump coronary artery bypass graft surgery vs mini-extracorporeal circuit.Chest. 2005; 127: 1190-1195
- Pulsatile Pulmonary perfusion during cardiopulmonary bypass reduces the pulmonary inflammatory response.Ann Thorac Surg. 2008; 86: 115-122
- Lung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy.Ann Thorac Surg. 2002; 74: 1167-1172
Article info
Publication history
Published online: December 04, 2009
Accepted:
October 5,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
