On-pump coronary surgery with and without cardioplegic arrest: comparison of inflammation, myocardial, cerebral and renal injury and early and late health outcome in a single-centre randomised controlled trial

Objective: To assess the safety and efficacy of on-pump beating heart coronary surgery on organ function, and early and late health outcome as compared with conventional technique. Methods: A total of 81 patients were randomised to (1) coronary surgery with cardiopulmonary bypass (CPB) and cardiople...

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Published in:	European journal of cardio-thoracic surgery 2011-05, Vol.39 (5), p.675-683
Main Authors:	Narayan, Pradeep, Rogers, Chris A, Bayliss, Kate M, Rahaman, Natasha C, Panayiotou, Nayia, Angelini, Gianni D, Ascione, Raimondo
Format:	Article
Language:	eng
Subjects:	Acetylglucosaminidase - urine Aged Biological and medical sciences Biomarkers - blood Brain Diseases - etiology Cardiology. Vascular system Cardiomyopathies - etiology Coronary Artery Bypass - adverse effects Coronary Artery Bypass - methods Coronary heart disease Creatinine - urine Female Follow-Up Studies Heart Heart Arrest, Induced - adverse effects Humans Inflammation - etiology Inflammation Mediators - blood Interleukins - blood Kidney Diseases - etiology Male Medical sciences Middle Aged Myocarditis. Cardiomyopathies Pneumology S100 Proteins - blood Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Treatment Outcome Troponin I - blood
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Summary:	Objective: To assess the safety and efficacy of on-pump beating heart coronary surgery on organ function, and early and late health outcome as compared with conventional technique. Methods: A total of 81 patients were randomised to (1) coronary surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) (on-pump with CA, n = 41) or to (2) CPB without CA (on-pump without CA, n = 40). Primary outcomes included serial measurement of interleukins (IL-6, IL-8 and IL-10) for inflammation, troponin I for myocardial injury, protein S100 for cerebral injury and creatinine clearance (CrCl) and urinary N-acetyl-β-d-glucosaminidase (NAG) for renal injury. In-hospital health outcome and 5-year event-free survival were secondary outcomes. Results: Baseline and intra-operative characteristics were similar between groups. A marked release of ILs was observed in both groups, but no significant differences between the groups were found (IL-6 +9%, 95% confidence interval (CI) −15% to +39%, p = 0.49; IL-8 +4%, 95% CI −34% to +63%, p = 0.86; IL-10 −0.1%, 95% CI −19% to +21%, p = 0.93). Troponin I rose in both groups and was on average 34% higher in the on-pump without CA group but this did not reach statistical significance (95% CI −0.4% to +87%, p = 0.08). S100 protein was higher in the on-pump without CA group at 12 h (p = 0.04) but did not differ at other times (p = 0.16). The level of CrCl was higher 1 h in the on-pump without CA group (+23%, 95% CI +1% to +50%, p = 0.04), but not thereafter. NAG release was similar in both groups (+1% 95% CI −23% to +33%, p = 0.91). Early and 5-year health outcomes were similar. Conclusions: On-pump without CA coronary surgery does not provide any obvious advantage when compared with the conventional technique of on-pump with CA in elective patients. Both techniques provide a comparable degree of inflammatory activation, myocardial, cerebral and renal injury with similar 5-year event-free survival.
ISSN:	1010-7940 1873-734X