Sage Journals: Discover world-class research

Abstract

Background

Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization.

Methods

In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A). Seven other animals served as controls and underwent standard myocardial revascularization with the same device as integrated pump of a complete heart-lung machine (group B). Blood samples for blood gas metabolism, creatine kinase (CK), troponin I, lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH) were taken before and after the entire operation.

Results

Comparing the baseline values, the increase of CK was more pronounced in group B than in group A (176.4 ± 41.2 to 279.7 ± 29 U/L vs. 274 ± 142.7 to 288.1 ± 118.6 U/L, respectively; p=0.0006). Increase of troponin I was significantly higher in group B than in group A (1 ± 0.3 to 2.9 ± 1 ng/mL vs. 1.1 ± 0.9 to 3 ± 3.8 ng/mL, respectively; p=0.002). LDH increase was also more pronounced in group B (231.7 ± 54.3 to 299.9 ± 39.8 U/L vs. 274.9 ± 59.7 to 263.8 ± 57.9 U/L, respectively; p=0.01). HBDH values increased significantly in group B after the operation (group A: 215.9 ± 34.7 to 200 ± 39.2 U/L vs. group B: 195.4 ± 41.7 to 274.9 ± 51.6 U/L; p=0.02). Hemodynamic measures and LDH values under luxation (group A: 1.9 ± 0.6 U/L; B: 3.5 ± 1 U/L, p=0.001) were also superior in the study group.

Conclusion

The current set-up might be superior to conventional extracorporeal circulation and thus be an alternative for high-risk candidates to avoid the adverse events of a complete heart-lung machine, when they are scheduled for complete myocardial revascularization.

Keywords

Blood pump Intermediate approach Off-pump revascularization On-pump revascularization

Get full access to this article

View all access options for this article.

References

da Vernnes

, Lachapelle

, Cecere

. Application of the Parsonenet scoring system for a Canadian cardiac surgery program. Can J Cardiol 2007; 23: 1061–5.

Wan

, LeClerc

J.L.

, Vincent

J.L.

. Inflammatory response to cardiopulmonary bypass: Mechanisms involved and possible therapeutic strategies. Chest 1997; 112: 676–92.

Fraund

, Behnke

, Böning

, Cremer

. Immediate postoperative extubation after minimally invasive direct coronary artery surgery (MIDCAB). Interact Cardiovasc Thorac Surg 2002; 1: 41–5.

Gerola

L.R.

, Buffalo

, Jasbik

. Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial. Ann Thorac Surg 2004; 77: 569–73.

Sergeant

, Wouters

, Meyns

. OPCAB versus early mortality and morbidity: An issue between clinical relevance and statistical significance. Eur J Cardiothorac Surg 2004; 25: 779–85.

Göbel

, Arvand

, Eilers

. Development of the MEDOS/HIA Deltastream extracorporeal rotary blood pump. Artif Organs 2001; 25: 358–65.

Göbel

, Arvand

, Rau

. A new rotary blood pump for versatile extracorporeal circulation: the Deltastream. Perfusion 2002; 17: 373–82.

Feindt

, Boeken

, Litmathe

. The Medos-Deltastream blood pump system. In: Feindt

, Vetter

H.O.

, Weyand

, eds. [Synopsis of biological and mechanical circulatory support] [in German]. Darmstadt, Germany: Steinkopff-Verlag, 2003; 57–63.

Garrett

H.E.

, Dennis

E.W.

, de-Bakey

M.E.

. Aortocoronary bypass with saphenous vein: seven year follow-up. JAMA 1973; 223: 792–4.

10.

Korn-Lubetzki

, Oren

, Asher

. Strokes after cardiac surgery: mostly right hemispheric ischemic with mild residual damage. J Neurol 2007; 254: 1708–13.

11.

Edmunds

L.H.

Jr. . Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 12–6.

12.

Salis

, Mazzanti

V.V.

, Merli

. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 814–22.

13.

Wendel

H.P.

, Philipp

, Weber

, Birnbaum

D.E.

, Ziemer

. Oxygenator thrombosis: worst case after development of an abnormal pressure gradient – Incidence and pathway. Perfusion 2001; 16: 271–88.

14.

Engoren

, Arslanian-Engoren

, Steckel

, Neihardt

, Fenn-Buderer

. Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery. Chest 2002; 122: 1309–15.

15.

Damiano

R.J.

, Reichenspurner

, Ducke

C.T.

. Robotically assisted endoscopic coronary artery bypass grafting: current state of the art. Adv Card Surg 2000; 12: 37–57.

16.

Riess

F.C.

, Bader

, Kremer

. Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up. Ann Thorac Surg 2002; 73: 1849–55.

17.

Agati

, Mignosa

, Ciccarello

, Salvo

, Undar

. Initial European clinical experience with pulsatile extracorporeal membrane oxygenation. J Heart Lung Transplant 2006; 25: 400–3.

18.

Boyd

W.D.

, Desai

N.D.

, Del Rizzo

D.F.

, Novivk

R.J.

, McKenzie

, Menkis

A.H.

. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg 1999; 68: 1490–3.

19.

Schulze

, Conrad

, Schutz

, Egi

, Reichenspurner

, Reichart

, Wildhirt

S.M.

. Reduced expression of systemic proinflammatory cytokines after off-pump versus conventional coronary artery bypass grafting. Thorac Cardiovasc Surg 2000; 48: 364–9.

20.

Angelini

G.D.

, Taylor

F.C.

, Reeves

B.C.

, Ascione

. Early and midterm outcome after off-pump and on-pump Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194–9.