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 subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

Methods. From June 1995 to June 1996, 62 consecutive patients with isolated stenosis of the left anterior descending coronary artery were assigned randomly to two groups: 31 patients underwent minimally invasive coronary artery bypass grafting and 31 patients underwent conventional coronary artery bypass grafting with cardiopulmonary bypass. In a subgroup of 10 patients in each group, subclinical markers were measured to determine the level of the inflammatory response generated during the operation.

Results. In the group that underwent minimally invasive coronary artery bypass grafting, leukocyte elastase, platelet beta-thromboglobulin, and complement C3a were unchanged at the end of the procedure compared with their baseline concentrations, 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 invasive coronary artery bypass grafting had a shorter duration of operation (104 +/- 28 versus 140 +/- 28 minutes; p <0.01), less blood loss (312 +/- 167 versus 788 +/- 365 mL; p <0.01), shorter ventilatory support (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.

Conclusions. These data suggest that patients who undergo minimally invasive 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.