Reduced expression of systemic proinflammatory and myocardial biomarkers after off-pump versus on-pump coronary...

Area of Science:

• Cardiovascular Surgery
• Inflammation Biology
• Myocardial Protection

Background:

• The comparative effects of off-pump coronary artery bypass grafting (OffPCABG) versus on-pump coronary artery bypass grafting (OnPCABG) on myocardial injury and inflammation remain incompletely understood.
• Investigating these differences is crucial for optimizing surgical techniques in coronary artery disease management.

Purpose of the Study:

• To compare the inflammatory response and myocardial injury between patients undergoing OffPCABG and OnPCABG.
• To assess the impact of cardiopulmonary bypass (CPB) on key biomarkers of cardiac stress and inflammation.

Main Methods:

• A prospective study involving patients with normal left ventricular function, randomized to either OffPCABG (n=40) or OnPCABG (n=41).
• Blood samples were collected preoperatively and 24 hours postoperatively to measure biomarkers including creatine kinase-MB (CK-MB), troponin I (cTnI), interleukin-6 (IL-6), interleukin-8 (IL-8), P-selectin, intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein (CRP).
• In-hospital and 12-month mortality rates were recorded.

Main Results:

• Postoperative levels of myocardial injury markers (CK-MB and cTnI) were significantly lower in the OffPCABG group compared to the OnPCABG group (P < .01).
• While both groups showed increased inflammatory markers (IL-6, IL-8, P-selectin, ICAM-1, CRP) 24 hours post-surgery, the OnPCABG group exhibited significantly higher levels of IL-8, P-selectin, and CRP compared to the OffPCABG group (P < .01).
• Elevated postoperative CRP levels in the OnPCABG group correlated significantly with adverse events, whereas mortality rates at 12 months did not differ significantly between the groups.

Conclusions:

• Off-pump CABG demonstrates a superior ability to preserve myocardium and attenuate the inflammatory response compared to on-pump CABG.
• Despite the observed benefits in myocardial protection and reduced inflammation, the absence of cardiopulmonary bypass during CABG did not translate into improved long-term survival in this study.
• The findings suggest that OffPCABG may be advantageous in minimizing surgical trauma, but further research is needed to elucidate its impact on long-term clinical outcomes.