Interleukin-1, interleukin-6 and myocardial enzyme response after coronaryartery bypass grafting - a prospective randomized comparison of the conventional and three minimally invasive surgical techniques

Objective: In order to evaluate the traumatic effects of median sternotomy and cardiopulmonary bypass (CPB) in conventional and minimally invasive cor onary artery bypass grafting, inflammatory response was studied in a prospe ctive randomized trial in patients referred to single-vessel coronary arter y bypass grafting. Methods: Four surgical techniques were compared: group I ,median sternotomy with CPB in ten patients (eight male, two female; aged 5 9.6 +/- 11.0 years (mean +/- SDI); group 2, median sternotomy and off-pump in ten patients (seven male, three female, aged 65.1 +/- 10.0 years), group 3, minithoracotomy with CPB in ten patients (seven male, three female, age d 61.2 +/- 10.4 years!; group 4, minithoracotomy and off-pump in ten patien ts (nine male, one female, aged 62.9 +/- 3.8 years). All patients received a left internal mammary artery graft to the left anterior descending artery (LAD). Clinical data, perioperative values of cytokines and cardiac enzyme s were monitored. Results. There were no major complications. Troponin-T an d creatine kinase isoenzyme MB (CK-MB) levels were significantly higher in CPB procedures (P < 0.0056; multivariate general linear model). Interleukin -6 (IL-6) levels were significantly higher in minithoracotomy procedures. I nterleukin-1 (IL-I) was significantly increased in all patients compared wi th the preoperative values. Conclusions: The use of CPB is combined with hi gher levels of troponin-T and CK-MB as signs of myocardial damage. Surgical access was identified as a trigger of inflammatory response, as minithorac otomy is related to higher levels of IL-6. IL-1 increased in ail procedures and this occurred independently of the surgical access or the use of CPB, which points out a potential relationship between inflammatory response and anesthesia. Neither CPB nor surgical access influenced the clinical outcom e in the treatment of coronary artery single-vessel bypass grafting. (C) 20 00 Elsevier Science B.V. All rights reserved.