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Original Articles: Adult Cardiac

Myocardial Revascularization by Left Ventricular Assisted Beating Heart Is Associated With Reduced Systemic Inflammatory Response

^a Cardiac Surgery Unit, School of Medicine, University Federico II, Naples, Italy
^b Cardiac Surgery Unit, Istituto Clinico Pineta Grande, Castel Volturno, Italy
^c ItalyCardiac Anaesthesia, Istituto Clinico Pineta Grande, Castel Volturno, Italy
^d ItalyLaboratory Medicine, Istituto Clinico Pineta Grande, Castel Volturno, Italy
^e Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
^f Cardiac Surgery Unit, S. Giovanni di Dio e Ruggi D'Aragona Hospital, Salerno, Italy

Accepted for publication July 29, 2008.

^_* Address correspondence to Dr Di Tommaso, Via V. Gemito, 33, Caserta, 81100, Italy (Email: lditommaso{at}tin.it).

Background: The present study was designed to investigate whether use of left ventricular assisted technique (LVA) in beating-heart myocardial revascularization would exert less impact on patients' inflammatory response, as compared with minimal extracorporeal circulation (MECC).

Methods: Seventy-three consecutive high-risk patients undergoing myocardial revascularization were randomly assigned either to LVA (group A) or to MECC (group B). Monocyte count and plasma concentration of C-reactive protein, inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor-, and polymorphonuclear elastase were measured at baseline and at various time points postoperatively.

Results: Preoperative clinical and demographic data did not differ between the two groups. The two groups also were similar with respect to mortality, number of grafts performed, duration of extracorporeal circulation, and need for inotropes. However, LVA was associated with significantly less inflammatory response postoperatively compared with MECC, as indicated by a significant difference in interleukin-6 (p = 0.002), C-reactive protein (p = 0.002), monocyte percentage (p = 0.006), tumor necrosis factor- (p = 0.002), and polymorphonuclear elastase (p = 0.001).

Conclusions: High-risk patients undergoing beating-heart myocardial revascularization with LVA show reduced inflammatory response compared with patients treated with the MECC.

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