Wittwer Thorsten, Choi Yeong-Hoon, Neef Klaus, Schink Mareike, Sabashnikov Anton, Wahlers Thorsten
Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Germany.
J Cardiothorac Surg. 2011 Oct 19;6:142. doi: 10.1186/1749-8090-6-142.
Off-pump-coronary-artery-bypass-grafting (OPCAB) and minimized-extracorporeal-circulation (Mini-HLM) have been proposed to avoid harmful effects of cardiopulmonary-bypass (CPB). Controversies exist whether OPCAB is still superior in perioperative outcome. Circulating endothelial cells (CEC) are sensitive markers of endothelial damage and are significantly elevated in conventional-CPB-procedures as compared to Mini-HLM-revascularisation. Therefore, CEC might be of specific value in evaluating effectiveness of Mini-HLM and OPCAB as currently applied less-invasive coronary procedures.
76 coronary patients were randomly assigned either to OPCAB (n = 34) or to Mini-HLM (ROCsafe™, Terumo Inc., n = 42) procedures. Perioperative data, clinical and serological outcome and measurements of CEC-release and parameters of endothelial function (v.Willebrand-Factor, soluble-thrombomodulin) perioperatively (pre-operative-baseline, post-Mini-HLM/release of OPCAB-stabilizer, 6 h, 12 h, 24 h and 5 days postoperatively) were obtained and compared by ANOVA models including repeated-measures-analysis.
Mean graft-number was 3.06 ± 0.72 in Mini-HLM-patients and 1.89 ± 0.74 in OPCAB-patients (p < 0.001). However, ventilation-, ICU- and total-hospital duration were comparable between groups as well as chest-tube-drainage, transfusion requirements, hemodynamics and catecholaminergic support (p > 0.05). CEC-release did not differ between groups (p = 0.274) and was generally within normal limits, Troponin-T levels where not significanty different (p = 0.108). No myocardial infarctions, strokes or deaths occurred, neuron specific enolase (NSE) did not show any differences between groups (p = 0.194).
Conceptional advantages of minimized CPB systems (ROCsafe™) result in morbidity and mortality comparable with OPCAB procedures. Mini-HLM therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity in high-risk patients while facilitating more complete revascularization in complex patients.
非体外循环冠状动脉搭桥术（OPCAB）和微创体外循环（Mini-HLM）已被提出用于避免体外循环（CPB）的有害影响。OPCAB在围手术期结果方面是否仍具有优势存在争议。循环内皮细胞（CEC）是内皮损伤的敏感标志物，与Mini-HLM血管重建相比，在传统CPB手术中显著升高。因此，CEC在评估Mini-HLM和OPCAB作为目前应用的微创冠状动脉手术的有效性方面可能具有特定价值。
76例冠心病患者被随机分配接受OPCAB（n = 34）或Mini-HLM（ROCsafe™，Terumo公司，n = 42）手术。获取围手术期数据、临床和血清学结果以及围手术期（术前基线、Mini-HLM后/OPCAB稳定器释放后、术后6小时、12小时、24小时和5天）CEC释放量和内皮功能参数（血管性血友病因子、可溶性血栓调节蛋白）的测量值，并通过包括重复测量分析的方差分析模型进行比较。
Mini-HLM组患者的平均移植血管数为3.06±0.72，OPCAB组为1.89±0.74（p < 0.001）。然而，两组之间的通气、重症监护病房和总住院时间以及胸管引流、输血需求、血流动力学和儿茶酚胺能支持相当（p > 0.05）。两组之间的CEC释放量无差异（p = 0.274），且总体在正常范围内，肌钙蛋白-T水平无显著差异（p = 0.108）。未发生心肌梗死、中风或死亡，神经元特异性烯醇化酶（NSE）组间无差异（p = 0.194）。
微创CPB系统（ROCsafe™）的概念优势导致其发病率和死亡率与OPCAB手术相当。因此，Mini-HLM将CPB相关的全身和器官损伤降至最低，低CEC值表明内皮完整性完好。此外，Mini-HLM在高危患者中将OPCAB的益处与低发病率相结合，同时便于复杂患者进行更完全的血管重建。
