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Massimo Caputo
Mark Yeatman
Pradeep Narayan
Giovanni Marchetto
Raimondo Ascione
Gianni D. Angelini
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Right arrow Minimally invasive surgery

Ann Thorac Surg 2002;74:2088-2095
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial

Massimo Caputo, MDa, Mark Yeatman, FRCSa, Pradeep Narayan, FRCSa, Giovanni Marchetto, MDa, Raimondo Ascione, MDa, Barnaby C. Reeves, PhDa, Gianni D. Angelini, FRCSa*

a Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom

Accepted for publication July 15, 2002.

* Address reprint requests to Dr Angelini, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
e-mail: g.d.angelini{at}bristol.ac.uk

BACKGROUND: Right ventricular assist devices (RVADs) have been proposed to improve exposure of the coronary arteries in off-pump surgery. In this study we investigated the impact of the A-Med RVAD on inflammatory response and organ function in patients undergoing coronary artery bypass grafting.

METHODS: Sixty patients were prospectively randomized to conventional surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest, beating heart surgery (off-pump), or beating heart surgery with the RVAD. Serial blood samples were collected postoperatively, for analysis of inflammatory markers, troponin I, protein S100, and free hemoglobin. Renal tubular function was assessed by measuring urine N-acetyl-glucosaminidase activity.

RESULTS: No hospital deaths or major postoperative complications occurred in the study population. Interleukin-6, interleukin-8, C3a, and troponin I levels after surgery were significantly higher in the CPB group compared with the off-pump and RVAD groups. Free hemoglobin levels immediately after the operation, peak and total S100 levels, and N-acetyl-glucosaminidase activity were also significantly higher in the CPB group.

CONCLUSIONS: Off-pump coronary revascularization, with or without RVAD, reduces inflammatory response, myocardial, neurologic, and renal injury, and decreases hemolysis when compared with conventional surgery with CPB and cardioplegic arrest.




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