DOES MINIMALY INVASIVE EXTRACORPOREAL CIRCULATION EFFECTIVE IN COMORBID PATIENTS

Roman A. Kornelyuk, Ivan P. Komkov, Egor S. Malyshenko, Georgiy P. Plotnikov, Vladimir M. Zemskov, Vadim A. Popov

Objective. 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. 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.