Comparison of m-RNA expression for inflammatory mediators in leukocytes between on-pump and off-pump coronary artery...

Area of Science:

• Cardiovascular Surgery
• Immunology
• Molecular Biology

Background:

• Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) triggers a systemic inflammatory response.
• This inflammation is primarily linked to cytokine release and myocardial ischemia during CPB.
• Off-pump CABG (OPCAB) presents a less invasive alternative to conventional CABG.

Purpose of the Study:

• To compare the inflammatory response at the mRNA level in patients undergoing CABG with and without CPB.
• To evaluate gene expression of proinflammatory cytokines and adhesion molecules before and after surgery.
• To determine if OPCAB reduces the inflammatory markers associated with on-pump CABG.

Main Methods:

• A study involving 20 patients undergoing isolated CABG, divided into on-pump (n=10) and off-pump (n=10) groups.
• Utilized semiquantitative reverse transcription polymerase chain reaction (RT-PCR) to assess gene expression.
• Analyzed leukocytes in peripheral blood for cytokines, adhesion molecules, and vasoactive substances pre- and post-surgery.

Main Results:

• Significant postoperative increase in mRNA expression for IL-1, IL-8, IL-10, TNF-alpha, HO-1, PECAM, and Mac-1 in the on-pump group (p<0.05).
• No significant increase in these inflammatory markers was observed in the off-pump group.
• These findings indicate a heightened inflammatory response in patients undergoing on-pump CABG.

Conclusions:

• OPCAB demonstrates a less invasive profile compared to on-pump CABG, based on mRNA levels of inflammatory markers.
• The direct interaction of blood with the synthetic surfaces of the CPB circuit is likely the primary driver of systemic inflammation.
• OPCAB may be preferable for mitigating the inflammatory consequences of cardiac surgery.