Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery 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 coronary artery bypass grafting, inflammatory response was studied in a prospective randomized trial in patients referred to single-vessel coronary artery bypass grafting. Methods: Four surgical techniques were compared: group I,median sternotomy with CPB in ten patients (eight male, two female; aged 59.6 +/- 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, aged 61.2 +/- 10.4 years!; group 4, minithoracotomy and off-pump in ten patients (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 enzymes were monitored. Results. There were no major complications. Troponin-T and 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. Interleukin-1 (IL-I) was significantly increased in all patients compared with the preoperative values. Conclusions: The use of CPB is combined with higher levels of troponin-T and CK-MB as signs of myocardial damage. Surgical access was identified as a trigger of inflammatory response, as minithoracotomy 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 outcome in the treatment of coronary artery single-vessel bypass grafting. (C) 2000 Elsevier Science B.V. All rights reserved.