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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Off-pump coronary artery bypass surgery is associated with reduced neutrophil activation as measured by the
Sharif Al-Ruzzeh1, Ginette Hoare, Nandor Marczin
1National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Harefield Hospital, Middlesex, United Kingdom. sharifalruzzeh@hotmail.com
Insights
Off-pump coronary artery bypass grafting (OPCAB) surgery shows lower neutrophil activation compared to conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). OPCAB results in fewer neutrophil activation markers despite higher circulating neutrophil counts.
Area of Science:
- Cardiovascular Surgery
- Inflammation and Immunology
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) surgery is linked to systemic inflammation.
- Neutrophil activation and sequestration are key inflammatory processes.
- Off-pump coronary artery bypass (OPCAB) may reduce this inflammatory response.
Purpose of the Study:
- To compare neutrophil activation between OPCAB and CABG with cardiopulmonary bypass (CPB).
- To investigate the impact of surgical technique on systemic inflammation markers.
Main Methods:
- A prospective randomized study involving 20 patients undergoing primary isolated CABG.
- Patients were divided into CPB and OPCAB groups.
- Blood samples analyzed for white cell counts, CD11b expression on neutrophils, and Interleukin-8 levels at multiple time points.
Main Results:
- Both groups showed increased white cell and neutrophil counts post-operation, higher in OPCAB at 5 hours.
- Interleukin-8 levels were elevated in the CPB group at 5 hours.
- CD11b expression, a marker of neutrophil activation, was significantly higher in the CPB group at 60 minutes.
Conclusions:
- Neutrophil activation, indicated by CD11b expression, is lower in OPCAB compared to CPB.
- OPCAB has higher neutrophil counts but fewer activation markers.
- Neutrophil sequestration in the CPB circuit may explain lower counts in the CPB group.
Background:
Coronary artery bypass grafting (CABG) surgery is associated with systemic inflammation. Activation of neutrophils is a crucial step in inflammation and results in neutrophil sequestration within the tissues. One of the potential advantages of performing off-pump coronary artery bypass (OPCAB) surgery is the attenuation of the systemic inflammatory response. This prospective randomized study compares neutrophil activation in patients undergoing OPCAB versus those undergoing CABG with cardiopulmonary bypass (CPB).
Methods:
Twenty patients undergoing primary isolated CABG were randomly divided prospectively into 2 groups: 1 group underwent CABG with CPB, and the other group underwent OPCAB. Central venous blood samples were obtained before skin incision and at 15 minutes, 60 minutes, 2 hours, 5 hours, and 24 hours following the initiation of CPB or application of the stabilization device. Differential white cell counts were measured with routine laboratory techniques. CD11b surface expression on neutrophils was measured by flow cytometry. Interleukin 8 levels in the plasma were measured by enzyme-linked immunosorbent assays.
Results:
The 2 groups were matched with respect to preoperative and operative characteristics. White cell and neutrophil counts rose in both groups following the operation but were significantly higher in the OPCAB group at 5 hours (P < .001 and P = .002, respectively). Interleukin 8 concentrations were significantly higher in the CPB group at 5 hours following the initiation of CPB (P = .034). CD11b levels were significantly higher in the CPB group at 60 minutes (P = .002).
Conclusion:
This prospective randomized study demonstrates that the activation of circulating neutrophils as measured by CD11b expression is lower following OPCAB than in CPB. Although OPCAB is associated with significantly higher neutrophil counts, these neutrophils exhibit fewer activation markers. The lower postoperative neutrophil counts occurring in the CPB group may be explained by the activation and consequent sequestration of the neutrophils in the CPB circuit and tissues.
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