Universität zu Köln

Wittwer, Thorsten, Choi, Yeong-Hoon, Neef, Klaus, Schink, Mareike, Sabashnikov, Anton ORCID: 0000-0002-6289-1035 and Wahlers, Thorsten (2011). Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage. J. Cardiothorac. Surg., 6. LONDON: BMC. ISSN 1749-8090

Full text not available from this repository.

Abstract

Background: 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. Methods: 76 coronary patients were randomly assigned either to OPCAB (n = 34) or to Mini-HLM (ROCsafe (TM), 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 (preoperative-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. Results: 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). Conclusion: Conceptional advantages of minimized CPB systems (ROCsafe (TM)) 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wittwer, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Choi, Yeong-Hoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Neef, Klaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Schink, Mareike UNSPECIFIED UNSPECIFIED UNSPECIFIED Sabashnikov, Anton UNSPECIFIED orcid.org/0000-0002-6289-1035 UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-487145
DOI:	10.1186/1749-8090-6-142
Journal or Publication Title:	J. Cardiothorac. Surg.
Volume:	6
Date:	2011
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1749-8090
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MINIMAL EXTRACORPOREAL-CIRCULATION; CARDIOPULMONARY BYPASS SYSTEM; GRAFT PATENCY; AORTIC-VALVE; REVASCULARIZATION; METAANALYSIS; DEFINITION; OUTCOMES Multiple languages Cardiac & Cardiovascular Systems; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/48714