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Off-pump bypass graft operation significantly reduces oxidative stress and inflammation
B M Matata1, A W Sosnowski, M Galiñanes
1Department of Surgery, University of Leicester, Glenfield Hospital, United Kingdom.
Insights
Off-pump coronary artery bypass surgery on a beating heart significantly reduces oxidative stress and inflammatory responses compared to traditional cardiopulmonary bypass (CPB). This approach offers a less inflammatory surgical option for patients.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Biochemistry
Background:
- Coronary artery bypass grafting (CABG) often involves cardiopulmonary bypass (CPB).
- CPB is associated with systemic oxidative stress and inflammatory reactions.
- Investigating alternative surgical methods to mitigate these CPB-related effects is crucial.
Purpose of the Study:
- To determine if off-pump coronary artery bypass (OPCAB) surgery on a normothermic beating heart reduces systemic oxidative stress and inflammation compared to CPB.
- To compare the levels of specific oxidative stress and inflammatory markers between OPCAB and CPB groups.
Main Methods:
- Utilized a cardiac stabilizer for performing coronary anastomoses on a beating heart, with or without CPB.
- Collected serial blood samples at various time points during and after surgery.
- Analyzed plasma for key oxidative stress markers (lipid hydroperoxides, protein carbonyls, nitrotyrosine) and inflammatory markers (Complement C3a, elastase, IL-8, TNF-alpha, sE-selectin).
Main Results:
- Patients undergoing CPB showed significant increases in lipid hydroperoxides, protein carbonyls, and nitrotyrosine.
- These oxidative stress markers were abolished or significantly reduced in the off-pump group.
- CPB led to rapid increases in complement C3a, elastase, IL-8, TNF-alpha, and sE-selectin, whereas these increases were blunted in the off-pump group.
Conclusions:
- Off-pump coronary artery bypass grafting on a beating heart effectively reduces systemic oxidative stress.
- This surgical technique significantly suppresses the inflammatory reaction typically associated with cardiopulmonary bypass.
- OPCAB presents a potentially less inflammatory alternative for coronary revascularization.
Background:
This study investigated whether off-pump coronary bypass graft operations on the beating heart under normothermic conditions reduces the systemic oxidative stress and inflammatory reaction seen in patients operated under cardiopulmonary bypass (CPB).
Methods:
A cardiac stabilizer (Octopus Tissue Stabilizer; Medtronic Inc, Minneapolis, MN) was used to perform the coronary anastomoses on the normothermic beating heart with or without CPB. Serial blood samples were taken at various intervals. Plasma was analyzed for several oxidative stress and inflammatory markers.
Results:
Significant increases from prior anesthesia values of lipid hydroperoxides (190% at 4 hours), protein carbonyls (250% at 0.5 hours) and nitrotyrosine (510% at 0.5 hours) were seen in the CPB group, but they were abolished or significantly reduced in the off-pump group. Complement C3a and elastase levels were rapidly increased upon the institution of CPB, and this was followed by increases in IL-8, TNF-alpha, and sE-selectin. In contrast, the rise of these factors was blunted in patients operated without CPB.
Conclusions:
Off-pump coronary bypass graft operation on a beating heart significantly reduces oxidative stress and suppresses the inflammatory reaction associated with the use of CPB.