REDUCTION OF THE INFLAMMATORY RESPONSE IN PATIENTS UNDERGOING MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING

Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclin ical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without car diopulmonary bypass. Methods. From June 1995 to June 1996, 62 consecut ive patients with isolated stenosis of the left anterior descending co ronary artery were assigned randomly to two groups: 31 patients underw ent minimally invasive coronary artery bypass grafting and 31 patients underwent conventional coronary artery bypass grafting with cardiopul monary bypass. In a subgroup of 10 patients in each group, subclinical markers were measured to determine the level of the inflammatory resp onse generated during the operation. Results. In the group that underw ent minimally invasive coronary artery bypass grafting, leukocyte elas tase, platelet beta-thromboglobulin, and complement C3a were unchanged at the end of the procedure compared with their baseline concentratio ns, whereas these inflammatory markers were increased significantly in the group that underwent conventional coronary artery bypass grafting with cardiopulmonary bypass. The patients who underwent minimally inv asive coronary artery bypass grafting had a shorter duration of operat ion (104 +/- 28 versus 140 +/- 28 minutes; p < 0.01), less blood loss (312 +/- 167 versus 788 +/- 365 mL; p < 0.01), shorter ventilatory sup port (7.7 +/- 4.1 versus 12.9 +/- 3.4 hours; p < 0.01), and a shorter postoperative hospital stay (4.4 +/- 1.7 versus 7.7 +/- 2.6 days; p < 0.01) than the patients who underwent the conventional procedure. Conc lusions. These data suggest that patients who undergo minimally invasi ve coronary artery bypass grafting have a significant reduction in the systemic inflammatory response, postoperative morbidity, and hospital stay compared with patients who undergo conventional coronary artery bypass grafting with cardiopulmonary bypass.