Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response
Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response
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DOI：
10.1016/j.ejcts.2009.11.010
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发表时间：
2010-04-01
影响因子：
3.4
通讯作者：
Renzulli, Attilio
中科院分区：
文献类型：
--
作者：
Onorati, Francesco;Rubino, Antonino S.;Renzulli, Attilio
目的：冠状动脉旁路移植术（CABG）后的不良预后与围手术期内皮活化和全身炎症反应有关。使用脉动式体外循环（PCPB）或体外循环CABG （OPCABG）可以最大限度地减少这些现象。我们比较了CABG合并PCPB、CABG合并线性CPB （LCPB）或OPCABG患者的生化和临床结果。方法：60例连续行选择性孤立冠脉搭桥的患者进行前瞻性随机分组试验，分别接受搏动式冠脉搭桥（A组，20例）、线性冠脉搭桥（B组，20例）或OPCABG （C组，20例）。术前、术中、术后检测促炎因子（白细胞介素-2、-6、-8）、抗炎因子（白细胞介素-10）和内皮标志物（血管内皮生长因子（VEGF）、单核细胞化学引诱蛋白(MCP)-1）水平。结果：VEGF和MCP-1水平在手术过程中均显著升高，但在OPCABG组中升高最少，总体上最低。在LCPB中，他们上升最多，总体上达到顶峰。在OPCABG期间，白介素-2水平保持稳定，但在PCPB和LCPB期间，白介素-2水平同样下降。白细胞介素-6和-8水平在两种CPB与OPCABG期间均显著升高。手术期间各组白细胞介素-10水平均显著升高，但OPCABG组升高最少，总体最低，PCPB组升高最多，总体最高。LCPB组插管时间、重症监护病房（ICU）住院时间和住院时间均明显长于其他两组。结论：LCPB可以促进内皮细胞的激活和细胞因子的分泌，从而延缓恢复。OPCABG与轻微的内皮活化和细胞因子反应相关。PCPB显著减轻内皮/细胞因子泄漏，导致与OPCABG后的医院结果相当。(C) 2009欧洲心胸外科协会。Elsevier B.V.版权所有。
Objective: Poor outcomes after coronary artery bypass grafting (CABG) have been linked to perioperative endothelial activation and systemic inflammatory responses. The use of pulsatile cardiopulmonary bypass (PCPB) or off-pump CABG (OPCABG) may minimise these phenomena. We compared biochemical and clinical outcomes among patients who underwent CABG with PCPB, CABG with linear CPB (LCPB) or OPCABG. Methods: Sixty consecutive patients undergoing isolated elective CABG were prospectively randomised trial to receive pulsatile CPB (group A, 20 patients), linear CPB (group B, 20 patients) or OPCABG (group C, 20 patients). Levels of proinflammatory cytokines (interteukins-2, -6, and -8), anti-inflammatory cytokines (interleukin-10) and endothelial markers (vascular endothelial growth factor (VEGF), monocyte chemo-attractant protein (MCP)-1) were measured before, during and after surgery. Results: VEGF and MCP-1 levels increased significantly during surgery in all groups, but they increased the least and were the lowest overall with OPCABG. They rose most and peaked overall with LCPB. Interteukin-2 levels remained stable during OPCABG but decreased equally during PCPB and LCPB. Interleukin-6 and -8 levels rose significantly during both types of CPB versus OPCABG. Interleukin-10 levels increased significantly in all groups during surgery, but they rose least and were the lowest overall with OPCABG and rose most and were the highest overall with PCPB. Intubation times, intensive care unit (ICU) stay and hospital stay were significantly longer in the LCPB group than the other two groups. Conclusions: LCPB appears to promote endothelial activation and cytokine secretion, which may delay recovery. OPCABG was associated with slight endothelial activation and cytokine response. PCPB significantly attenuates endothelial/cytokine leakage, resulting in hospital outcomes comparable with those after OPCABG. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.