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Eur J Cardiothorac Surg 2000;18:594-601
© 2000 Elsevier Science NL
a Cardiovascular Institute, University Hospital Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
b Institute for Laboratory Medicine, University Dresden, Dresden, Germany
Received 14 December 1999; received in revised form 14 July 2000; accepted 15 August 2000.
Corresponding author. Tel.: +49-351-450-1790; fax: +49-351-450-1512
e-mail: vassilios.gulielmos.hkz_dd{at}t-online.de
Objective: In order to evaluate the traumatic effects of median sternotomy and cardiopulmonary bypass (CPB) in conventional and minimally invasive coronary artery bypass grafting, inflammatory response was studied in a prospective randomized trial in patients referred to single-vessel coronary artery bypass grafting. Methods: Four surgical techniques were compared: group 1, median sternotomy with CPB in ten patients (eight male, two female; aged 59.6±11.0 years (mean±SD)); group 2, median sternotomy and off-pump in ten patients (seven male, three female; aged 65.1±10.0 years); group 3, minithoracotomy with CPB in ten patients (seven male, three female, aged 61.2±10.4 years); group 4, minithoracotomy and off-pump in ten patients (nine male, one female, aged 62.9±9.8 years). All patients received a left internal mammary artery graft to the left anterior descending artery (LAD). Clinical data, perioperative values of cytokines and cardiac enzymes were monitored. Results: There were no major complications. Troponin-T and creatine kinase isoenzyme MB (CK-MB) levels were significantly higher in CPB procedures (P<0.0056; multivariate general linear model). Interleukin-6 (IL-6) levels were significantly higher in minithoracotomy procedures. Interleukin-1 (IL-1) was significantly increased in all patients compared with the preoperative values. Conclusions: The use of CPB is combined with higher levels of troponin-T and CK-MB as signs of myocardial damage. Surgical access was identified as a trigger of inflammatory response, as minithoracotomy is related to higher levels of IL-6. IL-1 increased in all procedures and this occurred independently of the surgical access or the use of CPB, which points out a potential relationship between inflammatory response and anesthesia. Neither CPB nor surgical access influenced the clinical outcome in the treatment of coronary artery single-vessel bypass grafting.
Key Words: Inflammatory response • Cardiopulmonary bypass • Off-pump coronary artery bypass grafting • Cytokines • Troponin-T
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