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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
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Systemic inflammation after on-pump and off-pump coronary bypass surgery: a one-month follow-up

Alessandro Parolari1, Marina Camera, Francesco Alamanni

  • 1Department of Cardiac Surgery, Centro Cardiologico Monzino I.R.C.C.S, University of Milan, Italy. alessandro.parolari@cardiologicomonzino.it

The Annals of Thoracic Surgery
|August 28, 2007
PubMed

Insights

Coronary bypass surgery activates inflammation for days post-op. Both on-pump (CABG) and off-pump (OPCAB) strategies show similar protracted inflammation, indicating surgical approach does not impact this response.

Area of Science:

  • Cardiovascular Surgery
  • Inflammation Biology
  • Biomarker Analysis

Background:

  • Coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCAB) are surgical interventions for coronary heart disease.
  • Assessing postoperative inflammation is crucial for understanding patient recovery and potential complications.
  • The impact of surgical strategy on the duration and intensity of inflammation requires further investigation.

Purpose of the Study:

  • To evaluate and compare the activation of inflammatory markers following on-pump (CABG) versus off-pump (OPCAB) coronary bypass surgery.
  • To determine the duration of postoperative inflammation up to one month after surgery.
  • To identify specific inflammatory mediators affected by the surgical approach.

Main Methods:

  • A randomized controlled trial involving 30 patients undergoing coronary surgery.
  • Patients were allocated to either CABG (n=16) or OPCAB (n=14).
  • Blood samples were collected pre-operatively, post-protamine administration, and at 4, 8, and 30 days post-surgery to measure inflammatory markers.

Main Results:

  • Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels increased significantly from protamine administration up to 8 days post-surgery in both groups.
  • High-sensitivity C-reactive protein (hs-CRP) and fibrinogen also showed postoperative increases up to 8 days.
  • Neutrophil elastase levels were elevated post-surgery, with transient differences between CABG and OPCAB intraoperatively, but no significant differences postoperatively.

Conclusions:

  • Coronary bypass surgery leads to prolonged postoperative inflammation lasting several days.
  • The surgical strategy, whether on-pump (CABG) or off-pump (OPCAB), does not significantly alter the pattern or duration of this postoperative inflammatory response.
  • Postoperative increases in fibrinogen and hs-CRP correlated with IL-6 levels, suggesting a common inflammatory pathway.
Abstract

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