Does Minimaly Invasive Extra-corporeal Circulation Effective In Comorbid Patients
Vadim Popov, MD,PhD, Roman Kornelyuk, MD,PhD, Ivan Komkov, MD, Egor Malyshenko, MD, Georgy Plotnikov, MD, PhD, Vladimir Zemskov, MD, PhD, Amiran Revishvili, MD,PhD.
A.V.Vishnevsky Research Center of Surgery, Moscow, Russian Federation.
BACKGROUND: Comparison of clinical efficacy and severity of systemic inflammatory response in comorbid patients undergoing cardiac surgery under conditions of classical cardiopulmonary bypass (CPB) and MiECC. METHODS: A retrospective study of 67 consecutive patients with ischemic disease and/or valvular heart disease and comorbidities (diabetes mellitus, chronic kidney disease, obstructive pulmonary disease) operated on with EC ≥90 min. Comparison group (G1, n=51) - classical CPB, studied (G2, n=17) - MiECC 4 type of circuit. Standardized anesthetic support, one surgical team. According to the main parameters of perfusion - the duration of CPB, X-clamp time, the volume of blood loss, the groups are comparable. Control points - before CPB, at the end and after 24 hours. Descriptive statistics for scale variables are presented as M [Q25;75] (min; max). Fisher's exact method was used to analyze the compatibility of samples representing non-categorical data. The level of p<0.05 was accepted as a significant level of statistical significance.RESULTS: A retrospective study of 67 consecutive patients with ischemic disease and/or valvular heart disease and comorbidities (diabetes mellitus, chronic kidney disease, obstructive pulmonary disease) operated on with EC ≥90 min. Comparison group (G1, n=51) - classical CPB, studied (G2, n=17) - MiECC 4 type of circuit. Standardized anesthetic support, one surgical team. According to the main parameters of perfusion - the duration of CPB, X-clamp time, the volume of blood loss, the groups are comparable. Control points - before CPB, at the end and after 24 hours. Descriptive statistics for scale variables are presented as M [Q25;75] (min; max). Fisher's exact method was used to analyze the compatibility of samples representing non-categorical data. The level of p<0.05 was accepted as a significant level of statistical significance.RESULTS:There is a significant trend towards lower manifestations of markers of organ damage in the MiECC group - higher values of the PaO2/FiO2 index -300 [276;330] (253;360)] vs. 190 [168;227] (131;312) with a shorter duration of mechanical ventilation; significant intergroup difference in glomerular filtration rate; lower levels of lactate 1.5 [1.2;2.2] (0.5;3.2)] and hemolysis by fHb - 0.5 [0.3;0.65] (0.05;1.0). Data on markers of systemic inflammation are presented in the table:
| Parameter | G1, n=51 | G2, n=17 | р |
| Interleukin - 6, pg/ml | |||
| а. 1 h after CPB | 15,2[11,2-19,75](6,75;27,3) | 16,2[12-18,25](7,45;24,4) | 0,8044 |
| в. 24 h | 32,7[29,15-47,7](18,6;121,2) | 27,7[25,3-41,5](18,3;52,1) | 0,1041 |
| Interleukin -10, pg/ml | |||
| а. 1 h after CPB | 10,5[7,95-12,75](3,6;18,2) | 10,6[6,9-12,6](3,9;18,2) | 0,8023 |
| в. 24 h | 6,9[5,1-10,175](2,5;18,2) | 10,2[8,4-12,3](5,4;18,9) | 0,0109 |
| WBC, х109 | |||
| а. 1 h after CPB | 10,4[9,1-12,75](6,9;19,1) | 8,8[8,3-9,7](5,9;12,4) | 0,0100 |
| в. 24 h | 12,8[10,45-15,65](8,8;22,5) | 8,9[8,3-10,1](6,6;12,1) | <<0,05 |
| Procalcitonin, ng/ml | |||
| а. 1 h after CPB | 0,2[0,1-0,75](0.03;1,4) | 0,3[0,15-1,1](0,1;1,3) | 0,5659 |
| в. 24 h | 1,45[0,9-1,9](0,2;2,9) | 1[0,65-1,75](0,1;2,5) | 0,1733 |
| C-reactive protein, мг/л | |||
| а. 1 h after CPB | 5,6[3,9-9,2](2,9;14,8) | 5,5[4,1-8,4](2,9;12,1) | 0,8238 |
| в. 24 h | 7,8[6-11,35](3,3;16,4) | 7,5[4,9-10,6](3,9;18,3) | 0,4005 |
| sTrem-1, pg/ml | |||
| а. 1 h after CPB | 176[154,5-198](115;405) | 15 [129-182](112;211) | 0,0296 |
| в. 24 h | 184[159-213,5](118;335) | 131[120-156](107,3;172) | <<0,05 |
CONCLUSIONS: MiECC does not significantly affect the incidence of organ dysfunctions, but reduces the severity of the systemic inflammatory response and immune suppression, which may be relevant for patients with chronic organ dysfunctions
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