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Published on: September 15, 2023
Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial
Francesco Onorati1, Antonino S Rubino, Sergio Nucera
1Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy. frankono@libero.it
Insights
Off-pump CABG (OPCABG) and pulsatile cardiopulmonary bypass (PCPB) minimize inflammatory responses and endothelial activation after coronary artery bypass grafting (CABG). Linear CPB (LCPB) showed poorer outcomes, with longer recovery times.
Area of Science:
- Cardiovascular Surgery
- Inflammatory Response
- Endothelial Function
Background:
- Coronary artery bypass grafting (CABG) outcomes are affected by perioperative inflammation and endothelial activation.
- Pulsatile cardiopulmonary bypass (PCPB) and off-pump CABG (OPCABG) are potential strategies to mitigate these adverse effects.
Purpose of the Study:
- To compare biochemical and clinical outcomes in patients undergoing CABG using PCPB, linear CPB (LCPB), or OPCABG.
Main Methods:
- A prospective randomized trial involving 60 patients undergoing elective isolated CABG.
- Patients were assigned to PCPB (n=20), LCPB (n=20), or OPCABG (n=20).
- Measurements included proinflammatory cytokines (IL-2, IL-6, IL-8), anti-inflammatory cytokine (IL-10), and endothelial markers (VEGF, MCP-1) pre-, during, and post-surgery.
Main Results:
- OPCABG showed the least increase and lowest overall levels of VEGF and MCP-1; LCPB showed the highest.
- Interleukin-6 and -8 levels significantly increased with both CPB types compared to OPCABG.
- LCPB group experienced significantly longer intubation, ICU, and hospital stays compared to PCPB and OPCABG groups.
Conclusions:
- Linear CPB (LCPB) appears to exacerbate endothelial activation and cytokine release, potentially delaying patient recovery.
- Off-pump CABG (OPCABG) demonstrated minimal endothelial and cytokine response.
- Pulsatile cardiopulmonary bypass (PCPB) effectively attenuates endothelial/cytokine leakage, yielding hospital outcomes comparable to OPCABG.
Objective:
Poor outcomes after coronary artery bypass grafting (CABG) have been linked to perioperative endothelial activation and systemic inflammatory responses. The use of pulsatile cardiopulmonary bypass (PCPB) or off-pump CABG (OPCABG) may minimise these phenomena. We compared biochemical and clinical outcomes among patients who underwent CABG with PCPB, CABG with linear CPB (LCPB) or OPCABG.
Methods:
Sixty consecutive patients undergoing isolated elective CABG were prospectively randomised trial to receive pulsatile CPB (group A, 20 patients), linear CPB (group B, 20 patients) or OPCABG (group C, 20 patients). Levels of proinflammatory cytokines (interleukins-2, -6, and -8), anti-inflammatory cytokines (interleukin-10) and endothelial markers (vascular endothelial growth factor (VEGF), monocyte chemo-attractant protein (MCP)-1) were measured before, during and after surgery.
Results:
VEGF and MCP-1 levels increased significantly during surgery in all groups, but they increased the least and were the lowest overall with OPCABG. They rose most and peaked overall with LCPB. Interleukin-2 levels remained stable during OPCABG but decreased equally during PCPB and LCPB. Interleukin-6 and -8 levels rose significantly during both types of CPB versus OPCABG. Interleukin-10 levels increased significantly in all groups during surgery, but they rose least and were the lowest overall with OPCABG and rose most and were the highest overall with PCPB. Intubation times, intensive care unit (ICU) stay and hospital stay were significantly longer in the LCPB group than the other two groups.
Conclusions:
LCPB appears to promote endothelial activation and cytokine secretion, which may delay recovery. OPCABG was associated with slight endothelial activation and cytokine response. PCPB significantly attenuates endothelial/cytokine leakage, resulting in hospital outcomes comparable with those after OPCABG.
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