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Updated: Apr 20, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Off-pump myocardial revascularization attenuates endothelin-1 expression in systemic, pulmonary, and coronary
Daniel Unić1, Davor Barić, Kristina Brkić
1Department of Cardiac and Transplant Surgery, Dubrava University Hospital, Av. G. Šuška 6, HR-10 000, Zagreb, Croatia, dunic@kbd.hr.
Insights
Off-pump myocardial revascularization significantly reduces endothelin-1 (ET-1) levels compared to on-pump procedures. This finding suggests off-pump surgery may offer a protective effect against ET-1-related complications during cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Molecular Biology
- Biochemistry
Background:
- Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in cardiovascular disease.
- The impact of cardiopulmonary bypass (CPB) on ET-1 expression during myocardial revascularization is not fully understood.
Purpose of the Study:
- To evaluate the influence of cardiopulmonary bypass (CPB) on endothelin-1 (ET-1) expression in various circulation compartments.
- To compare ET-1 levels in patients undergoing myocardial revascularization with and without CPB.
Main Methods:
- Randomized controlled trial with 30 patients undergoing myocardial revascularization.
- Patients were assigned to either on-pump (CABG) or off-pump (OPCAB) procedures.
- ET-1 levels were measured in arterial, pulmonary, and coronary sinus blood at multiple time points.
Main Results:
- Off-pump myocardial revascularization (OPCAB) showed no significant variation in ET-1 levels.
- On-pump cardiopulmonary bypass (CABG) led to significant elevations in ET-1 levels across all measured vascular compartments.
- Elevated coronary sinus ET-1 levels post-CPB in the CABG group correlated with postoperative troponin-I levels.
Conclusions:
- Off-pump myocardial revascularization attenuates ET-1 expression in all investigated vascular compartments.
- Elevated coronary ET-1 levels after CPB in the CABG group correlate with myocardial injury markers.
Objective:
The objective of this study was to evaluate the influence of cardiopulmonary bypass (CPB) on endothelin-1 (ET-1) expression in various circulation compartments in patients undergoing myocardial revascularization.
Methods:
A total of 30 patients were randomized to undergo myocardial revascularization with (CABG, n = 15) or without (OPCAB, n = 15) CPB. Samples were taken preoperatively, after establishing CPB and after CPB (CABG group), prior to and after revascularization (OPCAB group), and 6 and 24 h postoperatively. Values of ET-1 were compared between groups at all time points and correlated with postoperative cardioselective enzyme values and clinical parameters.
Results:
In OPCAB group, ET-1 levels did not significantly vary between time points. In CABG group, ET-1 levels were significantly elevated vs. baseline in arterial: ART-T2 vs. ART-T0 (1.83 ± 1.81 vs. 0.76 ± 1.07 fmol/mL, p = 0.05), pulmonary: SG-T2 vs. SG-T0 (2.70 ± 2.75 vs. 0.39 ± 0.28 fmol/mL, p < 0.001) and SG-T3 vs. SG-T0 (1.56 ± 0.28 vs. 0.39 ± 0.28 fmol/mL, p < 0.001), and coronary circulation CS-T2 vs. CS-T1 (1.12 ± 0.49 vs. 0.27 ± 0.09 fmol/mL, p = 0.01). ET-1 levels were significantly higher in CABG group in all vascular compartments: ART-T2 (1.83 ± 1.81 vs. 0.17 ± 0.16 fmol/mL, p = 0.02), ART-T4 (0.99 ± 0.56 vs. 0.24 ± 0.12 fmol/mL, p = 0.01), SG-T1 (0.59 ± 0.15 vs. 0.25 ± 0.13 fmol/mL, p = 0.01), SG-T2 (2.70 ± 2.75 vs. 0.30 ± 0.24 fmol/mL, p = 0.004), SG-T3 (1.56 ± 0.28 vs. 0.35 ± 0.31 fmol/mL, p < 0.001), SG-T4 (1.34 ± 0.11 vs. 0.34 ± 0.16 fmol/mL, p < 0.001), and CS-T2 (1.12 ± 0.49 vs. 0.12 ± 0.12 fmol/mL, p = 0.004). Coronary sinus ET-1 level after CPB (CS-T2) in CABG group correlated positively with troponin-I level 24 h postoperatively (r(2) = 0.802, p = 0.02) CONCLUSION: Off-pump myocardial revascularization attenuates ET-1 expression in all investigated vascular compartments. Elevated coronary ET-1 levels after CPB in CABG group correlate with troponin-I levels 24 h postoperatively.
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