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Comparison of the Effects of Conventional and Minimally Invasive Cardiac Surgery with Cardiopulmonary Bypass on Inflammatory, Hepatic and Renal Parameters

Year 2025, Volume: 8 Issue: 2, 123 - 128, 30.06.2025
https://doi.org/10.36516/jocass.1652013

Abstract

Aim: Cardiac surgery has been performed by conventional methods for many years, but in recent years, minimally invasive cardiac surgery has come to the forefront. The aim of this study was to evaluate the effects of conventional and minimally invasive cardiac surgery performed under CPB guidance on inflammatory, hepatic and renal parameters.
Methods: In this retrospective study, those who underwent conventional cardiac surgery with CPB were defined as Group 1 and those who underwent minimally invasive cardiac surgery were defined as Group 2. Descriptive data of the groups, preoperative and postoperative urea, creatinine, ALT, AST, GGT, WBC, CRP data which are indicators of inflammatory, hepatic and renal functions, and peroperative variables such as intubation time, ICU time and hospital stay time were evaluated.
Results: In this study, demographic data of the two groups were similar (p > 0.05). Preoperative and postoperative inflammatory, hepatic, renal parameters (urea, creatinine, WBC, CRP, AST, ALT, GGT), ICU time, hospital stay and mortality rates were also similar (p > 0.05). However, there were statistically significant differences between the groups in terms of duration of AKI (p = 0.021), total perfusion time (p = 0.001) and mechanical ventilation time (p = 0.005), and these values were higher in Group 2.
Conclusion: Minimally invasive cardiac surgery performed under CPB guidance was associated with longer LOS, total perfusion time and duration of mechanical ventilation compared to conventional cardiac surgery. However, inflammatory, renal and hepatic parameters showed similar results, although there were no significant differences.

Ethical Statement

In this study, approval was obtained from the institutions and the local ethics committee (Harran University Clinical Research Ethics Committee) (Date: 22.07.2024 - Approval no: HRÜ/24.10.18). The study was conducted following the principles of the Declaration of Helsinki. Since only anonymized patient data was used and there was no risk or impact on patient care, informed consent was not required. This consent waiver was approved by the Institutional Review Board and Ethics Committee and complies with regulatory and ethical guidelines for retrospective studies.

References

  • Goldstone AB, Atluri P, Szeto WY, Trubelja A, Howard JL, MacArthur JW Jr, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2013;145(3):748-756. [Crossref]
  • Yaşar E, Duman ZM, Bayram M, Gürsoy M, Kadiroğulları E, Aydın Ü, et al. Minimally invasive versus conventional mitral valve surgery: A propensity score matching analysis. Turk Gogus Kalp Damar Cerrahisi Derg. 2023;31(4):498-506. [Crossref]
  • Ozgur MM, Aksut M, Ozer T, Gurel B, Yerli İ, Şimşek M, et al. Comparison of minimal invasive extracorporeal circulation versus standard cardiopulmonary bypass systems on coronary artery bypass surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2024;32(2):141-150. [Crossref]
  • Immer FF, Ackermann A, Gygax E, Stalder M, Englberger L, Eckstein FS, et al. Minimal extracorporeal circulation is a promising technique for coronary artery bypass grafting. Ann Thorac Surg. 2007;84(5):1515-1521. [Crossref]
  • Qiu Z, Chen X, Xu Y, Huang F, Xiao L, Yang T, et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?. J Cardiothorac Surg. 2018;13(1):29. [Crossref]
  • Abanoz M, Amaç B, Tercan M. Kardiyak cerrahide perfüzyon süresinin laktat düzeyi üzerine etkisi. ADYÜ Sağlık Bilimleri Derg. 2021;7(1):45-53. [Crossref]
  • Amaç B, Bağış MZ. Kardiyopulmoner Bypass Eşliğinde Kalp Kapak Cerrahisi Uygulanan Hastalarda Perfüzyon Süresinin Postoperatif Sonuçlar Üzerine Etkisi. BÜSAD. 2023;4(2):252-256. [Crossref]
  • Moh'd AF, Al-Odwan HT, Altarabsheh S, Makahleh ZM, Khasawneh MA. Predictors of aortic clamp time duration and intensive care unit length of stay in elective adult cardiac surgery. Egypt Heart J. 2021;73(1):92. [Crossref]
  • Asimakopoulos G. Systemic inflammation and cardiac surgery: an update. Perfusion. 2001;16(5):353-360. [Crossref]
  • Hill GE. Cardiopulmonary bypass-induced inflammation: is it important?. J Cardiothorac Vasc Anesth. 1998;12(2 Suppl 1):21-25.
  • Amaç B, Bağış MZ, Padak M. Comparison of De Ritis Rate for Del Nido Versus Blood Cardioplegia in Patients Who Underwent Coronary Artery Bypass Graft Under Cardiopulmonary Bypass. Journal of Cukurova Anesthesia and Surgical Sciences. 2024;7(3):144-148. [Crossref]
  • Akowuah EF, Maier RH, Hancock HC, Kharatikoopaei E, Vale L, Fernandez-Garcia C, et al. Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial. JAMA. 2023;329(22):1957-1966. [Crossref]
  • Bratt S, Dimberg A, Kastengren M, Lilford RD, Svenarud P, Sartipy U, et al. Bleeding in minimally invasive versus conventional aortic valve replacement. J Cardiothorac Surg. 2024;19(1):349. [Crossref]
  • Hancock HC, Maier RH, Kasim A, Mason J, Murphy G, Goodwin A, et al. Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial. BMJ Open. 2021;11(1):e041398. [Crossref]
  • Telyuk P, Hancock H, Maier R, Batty JA, Goodwin A, Owens WA, et al. Long-term outcomes of mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomized controlled trial. Eur J Cardiothorac Surg. 2022;63(1):ezac540. [Crossref]
  • Philip G, Bryndza MA, Konstanty-Kalandyk J, Piatek J, Wegrzyn P, Ceranowicz P, et al. Ministernotomy or sternotomy in isolated aortic valve replacement? Early results. Kardiochir Torakochirurgia Pol. 2018;15(4):213-218. [Crossref]
  • Ghanta RK, Lapar DJ, Kern JA, Kron IL, Speir AM, Fonner E Jr, et al. Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis. J Thorac Cardiovasc Surg. 2015;149(4):1060-1065. [Crossref]
  • Shehada SE, Elhmidi Y, Mourad F, Wendt D, El Gabry M, Benedik J, et al. Minimal access versus conventional aortic valve replacement: a meta-analysis of propensity-matched studies. Interact Cardiovasc Thorac Surg. 2017;25(4):624-632. [Crossref]
  • Rodríguez-Caulo EA, Guijarro-Contreras A, Guzón A, Otero-Forero J, Mataró MJ, Sánchez-Espín G, et al. Quality of Life After Ministernotomy Versus Full Sternotomy Aortic Valve Replacement. Semin Thorac Cardiovasc Surg. 2021;33(2):328-334. [Crossref]

Kardiyopulmoner Bypass Eşliğinde Yapılan Konvansiyonel ve Minimal İnvazif Kalp Cerrahisinin İnflamatuar, Hepatik ve Renal Parametreler Üzerine Etkilerinin Karşılaştırılması

Year 2025, Volume: 8 Issue: 2, 123 - 128, 30.06.2025
https://doi.org/10.36516/jocass.1652013

Abstract

Giriş: Kalp cerrahisi uzun yıllar konvansiyonel yöntemlerle yapılmıştır, ancak son yıllarda minimal invazif kalp cerrahisi yöntemi de ön plana çıkmıştır. Bu çalışmada KPB eşliğinde yapılan konvansiyonel ve minimal invazif kalp cerrahisinin inflamatuar, hepatik ve renal parametreler üzerine etkilerinin karşılaştırılmasını değerlendirmek amaçlandı.
Gereç ve Yöntemler: Retrospektif olarak yapılan bu çalışmada, KPB eşliğinde geleneksel kalp cerrahisi uygulananlar Grup 1, minimal invazif kalp cerrahisi uygulananlar ise Grup 2 olarak belirlendi. Çalışmada grupların tanımlayıcı verileri, preoperatif ve postoperatif inflamatuar, hepatik ve renal fonksiyonların göstergeleri olan üre, kreatin, ALT, AST, GGT, WBC, CRP verileri ve peroperatif değişkenlerinden entübe kalış süresi, ICU time, hastanede kalış süresi verileri değerlendirildi.
Bulgular: Bu çalışmada iki grubun demografik verileri benzerdi (p > 0.05). Grupların preoperatif ve postoperatif inflamatuar, hepatik, renal parametreleri (üre, kreatin, WBC, CRP, AST, ALT, GGT), ICU time, hastanede kalış süresi ve mortalite oranları da benzerdi (p > 0.05). Ancak AKK süresi (p = 0.021), total perfüzyon süresi (p = 0.001) ve mekanik ventilasyon süresi (p = 0.005) açısından gruplar arasında istatistiksel olarak anlamlı farklılıklar vardı ve bu değerler Grup 2'de daha yüksekti.
Sonuç: KPB eşliğinde gerçekleştirilen minimal invazif kalp cerrahisinin, konvansiyonel kalp cerrahisine kıyasla daha uzun AKK süresi, total perfüzyon süresi ve mekanik ventilasyon süresi ile ilişkili olduğu görülmüştür. Bununla birlikte, inflamatuar, renal ve hepatik parametrelerde belirgin farklılıklar olmamakla birlikte, benzer sonuçlar gösterdikleri de görülmüştür.

Ethical Statement

Bu çalışmada, çalışmanın yapıldığı kurumdan ve yerel etik kuruldan (Harran Üniversitesi Klinik Araştırmalar Etik Kurulu) onay alınmıştır (Tarih: 22.07.2024 - Onay no: HRÜ/24.10.18). Çalışma Helsinki Deklarasyonu ilkelerine uygun olarak yürütülmüştür. Yalnızca anonimleştirilmiş hasta verileri kullanıldığından ve hasta bakımı üzerinde herhangi bir risk veya etki olmadığından, bilgilendirilmiş onam gerekmemiştir. Bu onam feragati Kurumsal İnceleme Kurulu ve Etik Kurul tarafından onaylanmıştır ve retrospektif çalışmalar için düzenleyici ve etik kılavuzlara uygundur.

References

  • Goldstone AB, Atluri P, Szeto WY, Trubelja A, Howard JL, MacArthur JW Jr, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2013;145(3):748-756. [Crossref]
  • Yaşar E, Duman ZM, Bayram M, Gürsoy M, Kadiroğulları E, Aydın Ü, et al. Minimally invasive versus conventional mitral valve surgery: A propensity score matching analysis. Turk Gogus Kalp Damar Cerrahisi Derg. 2023;31(4):498-506. [Crossref]
  • Ozgur MM, Aksut M, Ozer T, Gurel B, Yerli İ, Şimşek M, et al. Comparison of minimal invasive extracorporeal circulation versus standard cardiopulmonary bypass systems on coronary artery bypass surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2024;32(2):141-150. [Crossref]
  • Immer FF, Ackermann A, Gygax E, Stalder M, Englberger L, Eckstein FS, et al. Minimal extracorporeal circulation is a promising technique for coronary artery bypass grafting. Ann Thorac Surg. 2007;84(5):1515-1521. [Crossref]
  • Qiu Z, Chen X, Xu Y, Huang F, Xiao L, Yang T, et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?. J Cardiothorac Surg. 2018;13(1):29. [Crossref]
  • Abanoz M, Amaç B, Tercan M. Kardiyak cerrahide perfüzyon süresinin laktat düzeyi üzerine etkisi. ADYÜ Sağlık Bilimleri Derg. 2021;7(1):45-53. [Crossref]
  • Amaç B, Bağış MZ. Kardiyopulmoner Bypass Eşliğinde Kalp Kapak Cerrahisi Uygulanan Hastalarda Perfüzyon Süresinin Postoperatif Sonuçlar Üzerine Etkisi. BÜSAD. 2023;4(2):252-256. [Crossref]
  • Moh'd AF, Al-Odwan HT, Altarabsheh S, Makahleh ZM, Khasawneh MA. Predictors of aortic clamp time duration and intensive care unit length of stay in elective adult cardiac surgery. Egypt Heart J. 2021;73(1):92. [Crossref]
  • Asimakopoulos G. Systemic inflammation and cardiac surgery: an update. Perfusion. 2001;16(5):353-360. [Crossref]
  • Hill GE. Cardiopulmonary bypass-induced inflammation: is it important?. J Cardiothorac Vasc Anesth. 1998;12(2 Suppl 1):21-25.
  • Amaç B, Bağış MZ, Padak M. Comparison of De Ritis Rate for Del Nido Versus Blood Cardioplegia in Patients Who Underwent Coronary Artery Bypass Graft Under Cardiopulmonary Bypass. Journal of Cukurova Anesthesia and Surgical Sciences. 2024;7(3):144-148. [Crossref]
  • Akowuah EF, Maier RH, Hancock HC, Kharatikoopaei E, Vale L, Fernandez-Garcia C, et al. Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial. JAMA. 2023;329(22):1957-1966. [Crossref]
  • Bratt S, Dimberg A, Kastengren M, Lilford RD, Svenarud P, Sartipy U, et al. Bleeding in minimally invasive versus conventional aortic valve replacement. J Cardiothorac Surg. 2024;19(1):349. [Crossref]
  • Hancock HC, Maier RH, Kasim A, Mason J, Murphy G, Goodwin A, et al. Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial. BMJ Open. 2021;11(1):e041398. [Crossref]
  • Telyuk P, Hancock H, Maier R, Batty JA, Goodwin A, Owens WA, et al. Long-term outcomes of mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomized controlled trial. Eur J Cardiothorac Surg. 2022;63(1):ezac540. [Crossref]
  • Philip G, Bryndza MA, Konstanty-Kalandyk J, Piatek J, Wegrzyn P, Ceranowicz P, et al. Ministernotomy or sternotomy in isolated aortic valve replacement? Early results. Kardiochir Torakochirurgia Pol. 2018;15(4):213-218. [Crossref]
  • Ghanta RK, Lapar DJ, Kern JA, Kron IL, Speir AM, Fonner E Jr, et al. Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis. J Thorac Cardiovasc Surg. 2015;149(4):1060-1065. [Crossref]
  • Shehada SE, Elhmidi Y, Mourad F, Wendt D, El Gabry M, Benedik J, et al. Minimal access versus conventional aortic valve replacement: a meta-analysis of propensity-matched studies. Interact Cardiovasc Thorac Surg. 2017;25(4):624-632. [Crossref]
  • Rodríguez-Caulo EA, Guijarro-Contreras A, Guzón A, Otero-Forero J, Mataró MJ, Sánchez-Espín G, et al. Quality of Life After Ministernotomy Versus Full Sternotomy Aortic Valve Replacement. Semin Thorac Cardiovasc Surg. 2021;33(2):328-334. [Crossref]
There are 19 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Articles
Authors

Murat Ziya Bağış 0000-0002-4088-7510

Bişar Amaç 0000-0003-0320-4239

Publication Date June 30, 2025
Submission Date March 5, 2025
Acceptance Date May 16, 2025
Published in Issue Year 2025 Volume: 8 Issue: 2

Cite

APA Bağış, M. Z., & Amaç, B. (2025). Comparison of the Effects of Conventional and Minimally Invasive Cardiac Surgery with Cardiopulmonary Bypass on Inflammatory, Hepatic and Renal Parameters. Journal of Cukurova Anesthesia and Surgical Sciences, 8(2), 123-128. https://doi.org/10.36516/jocass.1652013

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