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Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury
1Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT. swan@cuhk.edu.hk
Insights
Off-pump coronary artery bypass grafting significantly reduces inflammatory cytokine responses, specifically interleukin-8 and interleukin-10, leading to less myocardial injury compared to traditional cardiopulmonary bypass methods.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Biochemistry
Background:
- Proinflammatory cytokines are implicated in cardiac dysfunction post-cardiopulmonary bypass.
- Coronary artery bypass grafting (CABG) can involve cardiopulmonary bypass (CPB).
- Understanding cytokine profiles and myocardial injury is crucial for optimizing CABG procedures.
Purpose of the Study:
- To compare cytokine production and myocardial injury in patients undergoing CABG with or without CPB.
- To evaluate the impact of off-pump CABG on inflammatory markers and cardiac damage.
Main Methods:
- Forty-four patients with multivessel coronary artery disease were studied.
- Patients underwent either off-pump CABG or conventional CABG with CPB.
- Plasma cytokine levels (TNF-alpha, IL-6, IL-8, IL-10) and cardiac injury markers (CK-MB, troponin-I) were measured serially.
Main Results:
- Off-pump CABG resulted in significantly lower postoperative levels of IL-8 and IL-10 compared to CPB.
- Cardiac troponin-I levels, an indicator of myocardial injury, were significantly lower in the off-pump group.
- Postoperative troponin-I levels correlated with IL-8, suggesting a link between IL-8 and myocardial damage.
Conclusions:
- Coronary revascularization without cardiopulmonary bypass is associated with reduced inflammatory cytokine responses.
- Off-pump CABG demonstrates less myocardial injury compared to conventional CABG with CPB.
- Minimizing CPB may be beneficial in reducing perioperative cardiac damage and inflammation.
Background:
Proinflammatory cytokines play a key role in the inflammatory cascade after cardiopulmonary bypass and may induce cardiac dysfunction. We compared the production of cytokines and the degree of postoperative myocardial injury in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting through median sternotomy with or without cardiopulmonary bypass.
Methods:
Forty-four consecutive patients were studied. Patients were selected for off-pump coronary artery bypass grafting whenever complete revascularization was technically feasible. There were no differences between the two groups with respect to age, sex, symptoms, or functional class. Plasma levels of tumor necrosis factor-alpha, interleukin (IL)-6, IL-8, and IL-10 were measured before the operation, at the end of the procedure, and 2, 4, 8, 24, and 48 hours thereafter. Levels of the MB isoenzyme of creatine kinase and cardiac troponin-I were also measured after the operation.
Results:
The number of grafts was 2+/-0.7 in the off-pump group (n = 18) and 3+/-0.8 in the cardiopulmonary bypass group (n = 26). There were no deaths or major complications in either group. Levels of tumor necrosis factor-alpha were low in both groups. No significant intergroup differences were noted regarding serial IL-6 measurements. However, IL-8 and IL-10 levels after the operation were lower in the off-pump group (IL-8, 4+/-1 versus 38+/-12 pg/mL, p < 0.01; IL-10, 5+/-2 versus 191+/-33 pg/mL, p < 0.001). Whereas postoperative creatine kinase-MB values were similar in the two groups, cardiac troponin-I levels were significantly lower in the off-pump group (8 hours, p < 0.005; 24 hours, p < 0.02, respectively). Moreover, cardiac troponin-I values 24 hours after operation correlated strongly with IL-8 levels (r = 0.61, p < 0.005), indicating that the degree of myocardial injury may be related to IL-8 production.
Conclusions:
Compared with conventional coronary artery bypass grafting, coronary revascularization without cardiopulmonary bypass is associated with reduced cytokine responses and less myocardial injury.