The role of tissue factor and P-selectin in the procoagulant response that occurs in the first month after on-pump and off-pump coronary artery bypass grafting

BackgroundIt has been previously shown that a persistent (up to 1 month) prothrombotic status occurs after coronary bypass surgery performed both on pump and off pump. To assess the pathways involved in the occurrence of postoperative prothrombotic state, in this study we evaluated plasma, monocyte-bound, and platelet-bound tissue factor expression, as well as platelet and soluble P-selectin expression, up to 1 month after off-pump and on-pump coronary artery bypass grafting.MethodsThirty patient candidates for coronary surgery were randomized to undergo off-pump coronary artery bypass grafting (n = 15) or on-pump coronary artery bypass grafting (n = 15). Blood samples were collected before the intervention, after protamine administration, and 4, 8, and 30 days after surgical intervention.ResultsPlasma tissue factor levels were significantly higher than baseline both in the on-pump coronary artery bypass grafting group (from protamine administration up to 4 postoperative days) and in the off-pump coronary artery bypass grafting group (at 4 postoperative days), with no differences between groups. Basal and lipopolysaccharide-stimulated monocyte tissue factor expression, as well as basal and adenosine diphosphate–stimulated platelet tissue factor expression, did not show significant variations over time and were similar in the on-pump and off-pump coronary artery bypass grafting groups throughout the course of the study. Platelet expression of P-selectin, both basal and after adenosine diphosphate stimulation, did not significantly change over time and was not different in the on-pump and off-pump coronary artery bypass grafting groups. Soluble P-selectin levels in plasma were significantly higher in patients receiving on-pump coronary artery bypass grafting only at the time point after protamine administration, whereas this variable behaved similarly in the on-pump and off-pump coronary artery bypass grafting groups for the whole postoperative period.ConclusionsThe postoperative tissue factor and P-selectin expression did not differ between the on-pump and off-pump coronary artery bypass grafting groups. The distinct increase of plasma tissue factor occurring after both surgical procedures might represent a mechanism that might explain, in part, the early postoperative prothrombotic state occurring after on-pump and off-pump coronary artery bypass grafting

Minimally Invasive Vs. Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses

BACKGROUND: Aim of this multicenter retrospective study was to compare early and mid- term clinical and hemodynamic results of aortic valve replacement (AVR) with rapid-deployment bioprostheses (RDB) performed through conventional full-sternotomy versus mini-sternotomy.METHODS: Data from the Italian multicenter registry of AVR with RDB (INTU-ITA registry) were analyzed. Patients were divided into two groups: full sternotomy (FS) and mini-sternotomy (MS). Primary endpoint was the comparison of early and mid-term mortality. Secondary endpoints were: comparison of intra-operative variables, complications and hemodynamic performance. A propensity score weighting approach was employed for data analysis.RESULTS: A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in Group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (p=0.074). CPB time was 78.5 minutes and 83 minutes in FS and MS group, respectively (p=0.414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively with no significant differences between groups. Survival at 1, 3, 5 years was 94.1% and 98.1%, 88.5% and 91.8%, 85.2% and 84.8% in FS and MS groups, respectively (p=0.412). The two groups showed similar postoperative gradients (Median mean gradient, FS: 10.0 mmHg, MS: 11.0 mmHg; p=0.170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%,p=0.647).CONCLUSIONS: According to our data, RDB allow to perform minimally-invasive AVR with similar surgical times and similar clinical and hemodynamic outcomes than conventional surgery and should be considered the first choice in these procedures