Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic...

Area of Science:

• Cardiovascular Surgery
• Immunology
• Vascular Biology

Background:

• Coronary artery bypass graft (CABG) surgery, particularly on-pump CABG using cardiopulmonary bypass (CPB), is associated with significant postoperative organ failure.
• A systemic inflammatory response is often triggered by CPB during on-pump CABG.
• The endothelium's role in organ failure post-CABG is increasingly recognized.

Purpose of the Study:

• To compare the systemic inflammatory response between on-pump and off-pump CABG procedures.
• To investigate the levels of inflammatory cytokines, soluble adhesion molecules, and angiogenic factors in patients undergoing CABG.
• To assess the impact of CPB avoidance on endothelial activation and inflammatory markers.

Main Methods:

• Randomized controlled trial involving 60 patients undergoing elective CABG.
• Patients were assigned to either on-pump CABG or off-pump CABG.
• Plasma samples collected at baseline, post-sternum closure, 6 hours, and 24 hours postoperatively for biomarker analysis.

Main Results:

• On-pump CABG showed significantly higher increases in tumor necrosis factor-α, interleukin 10, and myeloperoxidase compared to off-pump CABG post-sternum closure.
• Interleukin 6 levels did not differ significantly between the two groups.
• Soluble endothelial adhesion molecules (E-selectin, VCAM-1, ICAM-1) were not elevated in either group during or after surgery.
• Angiopoietin 2 increased 24 hours postoperatively in both groups.
• Off-pump CABG exhibited higher levels of sFlt-1 after sternum closure compared to on-pump CABG.

Conclusions:

• Avoiding cardiopulmonary bypass and aortic cross-clamping during CABG surgery effectively reduces the systemic inflammatory response.
• On-pump CABG is associated with a greater inflammatory burden compared to off-pump CABG, evidenced by specific cytokine and marker elevations.
• The study indicates that off-pump CABG does not lead to increased circulating soluble endothelial adhesion molecules compared to on-pump CABG.