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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial function: a
Mats Johansson-Synnergren1, Folke Nilsson, Anders Bengtsson
1Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
Off-pump coronary artery bypass grafting (CABG) surgery reduces complement activation compared to on-pump CABG. However, both methods do not significantly differ in cytokine release or endothelial function post-surgery.
Area of Science:
- Cardiovascular Surgery
- Inflammatory Response
- Endothelial Function
Background:
- Cardiac surgery can trigger a systemic inflammatory response.
- This inflammatory response may negatively impact endothelial function.
- Investigating surgical techniques to mitigate these effects is crucial.
Purpose of the Study:
- To compare the inflammatory response between off-pump CABG (OPCAB) and conventional on-pump CABG.
- To assess the impact of OPCAB on endothelial function versus on-pump CABG.
Main Methods:
- Prospective, randomized study of 52 patients undergoing elective CABG.
- Comparison of 26 patients undergoing OPCAB versus 26 patients undergoing on-pump CABG.
- Measurement of inflammatory markers (C3a, IL-8, TNF-alpha, neopterin) and endothelin-1.
- Assessment of endothelial function via forearm plethysmography and acetylcholine infusion.
Main Results:
- Significantly higher levels of C3a and neopterin observed in the on-pump CABG group during and after surgery.
- Trends for higher TNF-alpha and IL-8 in the on-pump CABG group did not reach statistical significance.
- No significant difference in endothelial function between the OPCAB and on-pump CABG groups.
Conclusions:
- OPCAB effectively reduces complement activation compared to on-pump CABG.
- OPCAB does not significantly alter the release of TNF-alpha and IL-8 compared to on-pump CABG.
- Neither surgical approach demonstrates a significant advantage in preserving endothelial function in this study.
Objective:
Cardiac surgery initiates a systemic inflammatory response, which may affect endothelial function. The aim of this study was to investigate if off-pump CABG (OPCAB) reduces the postoperative inflammatory response and affects endothelial function less than conventional on-pump CABG.
Design:
Fifty-two patients submitted for elective CABG were included in a prospective, randomized study. Twenty-six patients were operated with, and 26 without cardiopulmonary bypass (CPB). Plasma levels of complement (C3a), cytokines (IL-8, TNF-alpha), endothelin-1 and neopterin were measured before and during surgery and 2 and 24 h after surgery. Endothelial function was assessed by forearm plethysmography and acetylcholine infusion in 30 patients 2-4 h after surgery.
Results:
C3a and neopterin concentrations were significantly higher during and early after surgery in the CPB group while TNF-alpha and IL-8 tended to be higher in the CPB group but the difference did not reach statistical significance. Endothelial function did not differ significantly between the two groups.
Conclusion:
OPCAB reduces complement activation compared with on-pump CABG but does not significantly affect TNF-alpha and IL-8 release or endothelial function.
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