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Similarity of coagulation and inflammation despite different surgical revascularization strategies - a prospective

Hagen Gorki1, Markus Hoenicka1, Patricia Rupp1

  • 1Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany.

Perfusion
|May 15, 2016
PubMed

Insights

Minimally invasive cardiac surgery techniques, including off-pump coronary artery bypass grafting (ONCAB), do not offer advantages over conventional methods regarding inflammation and coagulation. ONCAB showed transient increases in certain markers, but differences were not significant at 72 hours postoperatively.

Area of Science:

  • Cardiovascular Surgery
  • Hemostasis and Thrombosis
  • Inflammation and Immunology

Background:

  • Conventional extracorporeal circulation (ECC) is associated with inflammation and coagulation disturbances.
  • Minimally invasive techniques like minimized ECC and off-pump revascularization (ONCAB) are proposed alternatives.
  • The comparative impact of these techniques on perioperative hemostasis and inflammation requires clarification.

Purpose of the Study:

  • To compare the effects of conventional ECC, minimized ECC, and ONCAB on coagulation and inflammation markers.
  • To determine if minimally invasive cardiac surgery reduces perioperative inflammatory and coagulation disturbances.
  • To assess the long-term (72 hours) impact of different cardiopulmonary bypass strategies.

Main Methods:

  • Prospective randomized trial involving 120 coronary artery bypass graft (CABG) patients.
  • Patients were assigned to one of three surgical techniques: conventional ECC, minimized ECC, or ONCAB.
  • Measurement of coagulation factors, C-reactive protein, and other inflammatory markers up to 72 hours postoperatively.

Main Results:

  • Coagulation factors (I, II, V, X) and antithrombin III did not differ significantly between groups.
  • ONCAB demonstrated transient increases in thrombin-antithrombin complexes, D-dimers, tissue factor pathway inhibitor, factor VIII, and tumor necrosis factor α.
  • Leukocyte and platelet counts were lower in ONCAB, with higher soluble P-selectin and intercellular adhesion molecule 1 at certain time points.

Conclusions:

  • ONCAB does not appear to have a detrimental influence on common coagulation pathways, despite transient marker elevations.
  • Increased perioperative coagulation markers in ONCAB may reflect recirculation of pericardial blood.
  • Alternatives to ONCAB showed no significant advantage at 72 hours postoperatively, suggesting the role of modern ECC may be overestimated.
Abstract

Keywords:
CABGCPBcoagulation/anticoagulationinflammation

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