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Off-pump coronary artery bypass attenuates transient hepatocellular damage after myocardial revascularization
Tatsuya Yamada1, Ryoichi Ochiai, Junzo Takeda
1Department of Anesthesiology, School of Medicine, Keio University, 35 Shinanoma-chi, Shinjuku-hu, Tokyo, Japan. koanes@sc.itc.keio.ac.jp
Insights
Cardiopulmonary bypass (CPB) surgery causes temporary liver cell damage. Off-pump coronary artery bypass grafting significantly reduces this hepatocellular injury compared to on-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Hepatology
- Anesthesiology
Background:
- Cardiopulmonary bypass (CPB) can compromise hepatocellular integrity, leading to liver dysfunction post-cardiac surgery.
- Off-pump coronary artery bypass graft (CABG) surgery is explored as a method to mitigate this risk and preserve liver function.
Purpose of the Study:
- To compare perioperative hepatocellular damage between on-pump and off-pump coronary artery bypass surgery.
- To evaluate the impact of CPB on liver function using sensitive biomarkers.
Main Methods:
- Prospective study conducted at a university hospital.
- Involved 21 patients undergoing on-pump CABG and 17 patients undergoing off-pump CABG.
- Assessed liver function via serum levels of alcohol dehydrogenase (AD) and alpha-glutathione S-transferase (alpha-GST) at six time points.
Main Results:
- Off-pump surgery patients exhibited significantly lower increases in serum AD and alpha-GST levels compared to on-pump patients.
- Serum AD and alpha-GST levels rose in on-pump patients post-CPB, peaking at surgery's end.
- No clinically significant liver dysfunction was observed in either group.
Conclusions:
- CPB is associated with transient, subclinical hepatocellular damage.
- Off-pump coronary artery revascularization effectively attenuates this perioperative liver injury.
Objective:
Cardiopulmonary bypass (CPB) affects hepatocellular integrity and occasionally results in liver dysfunction after cardiac surgery. Performing coronary artery bypass graft surgery without CPB may help to reduce the risk of this complication and better preserve perioperative liver function. This study compared perioperative hepatocellular damage in patients undergoing on-pump and off-pump bypass surgery.
Design:
Prospective study.
Setting:
University hospital.
Participants:
Patients scheduled for elective on-pump (n = 21) and off-pump (n = 17) coronary artery bypass surgery.
Measurements And Main Results:
Liver function was assessed by serum levels of alcohol dehydrogenase (AD) and alpha-glutathione S-transferase (alpha-GST), which serve as more sensitive indices of hepatocellular injury than do conventional transaminases. Arterial blood was sampled at 6 stages: after induction of anesthesia (baseline); at the end of CPB in the on-pump group or on completion of the last distal anastomosis in the off-pump group; at the end of surgery; and 6 hours, 12 hours, and 24 hours after the end of anesthesia. The off-pump patients showed significantly lower increases in serum AD and alpha-GST levels than did the on-pump group. AD and alpha-GST values increased in the on-pump patients after the initiation of CPB and peaked at the end of surgery, with a return to baseline at 12 hours and 24 hours after the end of anesthesia. No clinically relevant liver dysfunction was observed in either group.
Conclusions:
CPB induced transient subclinical hepatocellular damage, whereas off-pump revascularization attenuated this damage.
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