Comparison of post-operative inflammatory biomarkers between minimal invasive extracorporeal circulation and conventional extracorporeal circulation in cardiac surgery. A meta-analysis of 15 randomized control trials

Background/Aim Recent literature suggested that the use of Minimal Invasive Extracorporeal Circulation (MIECC) may mitigate the inflammatory response in patients undergoing cardiac surgery. We aimed to perform a meta-analysis to compare post-operative inflammatory biomarkers between MIECC and conventional cardiopulmonary bypass in cardiac surgery. Methods We searched PubMed, Web of Science, Scopus, and Cochrane Library for randomized control trials (RCTs) that quantified systemic inflammatory mediators after the use of MIECC compared to conventional extracorporeal circulation (CECC). Results Fifteen RCTs with a total of 1189 patients were identified. The inflammatory markers that were investigated included Tumor Necrosis Factor α (TNF-α), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10), Elastase, C-Reactive protein (CRP) in addition to leucocyte count. No significant difference between both groups was detected for TNF-α and IL-6 at (30 minutes, 1 to 2 hours, 6 hours, 24 hours, and 48 hours), IL-8 at (30 minutes and 48 hours), Interleukin 10 at 6 hours, Elastase at (30 minutes to 1 hour, and 24 hours), CRP at 48 hours, and leucocytic count at (2 hours, 6 hours, 24 hours, and 48 hours). Pooled analysis showed a significant association between MIECC group and lower levels of TNF-α at 6 hours ( p -value <.0001), IL-8 at 6 hours ( p -value = .0005) and 24 hours ( p -value = .005), IL-10 at 24 hours ( p -value <.00,001), and Elastase at 6 hours ( p -value = .04). However, CRP was lower, at 24 hours, in the CECC group (MD = 1.42, 95% CI = 0.13 to 2.71, p -value = .03). Conclusion Our findings suggest that MIECC may be associated with lower levels of systemic inflammatory mediators early after cardiac surgery. However, the impact of this reduction on clinical outcomes needs to be defined to justify the use of MIECC in the routine clinical practice.