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Comparison of inflammatory response following coronary revascularization with or without cardiopulmonary bypass
Balázs Gasz1, László Benkö, Gábor Jancsó
1Department of Experimental Surgery, University of Pécs, Medical Faculty, Hungary;
Insights
Off-pump coronary artery bypass grafting significantly reduces inflammatory responses compared to on-pump procedures. This technique minimizes systemic inflammation markers like tumor necrosis factor-alpha and white blood cell counts post-surgery.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Inflammation Research
Background:
- Conventional coronary revascularization using cardiopulmonary bypass (CPB) triggers a significant systemic inflammatory response.
- Understanding and mitigating this inflammatory cascade is crucial for improving patient outcomes after cardiac surgery.
Purpose of the Study:
- To compare the inflammatory effects of on-pump versus off-pump coronary artery bypass grafting (CABG).
- To evaluate specific inflammatory markers including tumor necrosis factor-alpha, white blood cell counts, and leukocyte adhesion molecule expression.
Main Methods:
- A prospective, randomized study involving 20 patients undergoing CABG, divided into on-pump (CPB group) and off-pump (OPCAB group) cohorts.
- Serial blood sampling and analysis of inflammatory markers (TNF-alpha, WBC, neutrophils, CD11/CD18 expression) at multiple time points.
- Enzyme-linked immunosorbent assay and flow cytometry were employed for precise measurements.
Main Results:
- Both on-pump and off-pump CABG increased WBC and neutrophil counts post-operatively, with significantly higher levels in the on-pump group by day 7.
- Tumor necrosis factor-alpha levels were significantly elevated in the on-pump group on postoperative day 2.
- Leukocyte adhesion molecule expression (CD11a, CD18) showed significant differences between groups on postoperative day 2, with distinct temporal patterns.
Conclusions:
- Off-pump coronary artery bypass grafting significantly attenuates the systemic inflammatory response associated with extracorporeal circulation.
- The off-pump technique offers a potential advantage in reducing post-operative inflammation compared to traditional on-pump methods.
Background:
It is well known that conventional coronary revascularization is associated with a pronounced systemic inflammatory response due to the application of cardiopulmonary bypass (CPB).
Objective:
To compare the effects of coronary artery bypass grafting (CABG) with (on-pump) or without (off-pump) extra-corporeal circulation observing certain inflammatory response parameters.
Methods:
TWENTY PATIENTS UNDERGOING CABG WITH (CPB GROUP: 10 patients) or without (off-pump coronary artery bypass grafting [OPCAB] group: 10 patients) CPB were enrolled in this prospective, randomized study. Blood samples were collected three times during the operation and on postoperative days 1, 2, 3 and 7. The plasma level of proinflammatory cytokine tumor necrosis factor (TNF)-alpha was measured by enzyme-linked immunosorbent assay method following stimulation, and the expression of adhesion molecules (CD11, CD18) of leukocytes were determined by flow cytometry. Furthermore, white blood cell (WBC) and neutrophil count were carried out.
Results:
The WBC and neutrophil counts rose markedly in both groups following the operation and remained at this increased level during the observation period. There was a significant difference in WBC and neutrophil counts between the two groups of patients on postoperative day 7. A significant difference in the level of TNF-alpha was found between the two groups on postoperative day 2 (P<0.05). An intense increase was observed with CPB, which significantly exceeded the values of the OPCAB group without extracorporeal circulation in the early postoperative period. The CD11a and CD18 expression of leukocytes decreased during the operation and on postoperative day 1; thereafter, it increased markedly. There was a significant difference in adhesion molecule expression between the two groups on postoperative day 2.
Conclusion:
The investigation revealed that inflammatory response reactions following extracorporeal circulation could be reduced significantly using the off-pump technique.
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