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Published on: March 27, 2018
Decrease of Perforin Expressing Lymphocytes after On-Pump Coronary Artery Bypass Grafting Surgery Irrespective of
Jadranko Sokolic1, Danijel Knezevic1, Janja Kuharic1
1Department of Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia.
Insights
On-pump coronary artery bypass grafting (CABG) surgery, unlike off-pump CABG, significantly reduces T lymphocytes and natural killer cells. Preoperative carbohydrate feeding did not alter these immune cell changes after CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- CABG can be performed on-pump (using cardiopulmonary bypass) or off-pump.
- On-pump CABG is known to affect cell immunity during the perioperative and early postoperative periods.
Purpose of the Study:
- To investigate the impact of preoperative oral carbohydrate feeding on peripheral blood lymphocyte subsets and perforin expression.
- To compare these effects in patients undergoing on-pump versus off-pump CABG.
- To understand the immune response regulation following surgical revascularization.
Main Methods:
- A prospective study of 80 patients undergoing CABG, randomized into four groups (on-pump/off-pump, with/without carbohydrate feeding).
- Blood samples collected preoperatively and at 24 and 72 hours post-surgery.
- Flow cytometry used to analyze lymphocyte subsets (T cells, NK, NKT cells) and perforin expression.
Main Results:
- On-pump CABG led to a significant decrease in CD3+ and CD3+CD4+ T cells 24 hours post-surgery compared to off-pump CABG.
- Perforin expression in CD3+CD8+ cells also decreased significantly after on-pump CABG versus off-pump CABG.
- Preoperative carbohydrate feeding did not influence lymphocyte subpopulations or perforin expression at any time point.
Conclusions:
- On-pump CABG significantly reduces specific T lymphocyte subsets and perforin-expressing CD8+ T cells compared to off-pump CABG.
- These immune changes occur irrespective of preoperative oral carbohydrate administration.
- The findings highlight differences in immune response between on-pump and off-pump CABG procedures.
Background:
Coronary artery bypass grafting (CABG) surgery continues to be the gold standard for treating the patients with coronary artery disease. CABG surgery can be performed on or off cardiopulmonary bypass, termed as on-pump or off-pump CABG, respectively. It has been shown that CABG surgery, preferably on-pump CABG surgery, leads to the changes of cell immunity during perioperative and early postoperative period. The mechanisms of regulation of the immune response in patients during and early after surgical revascularization are not fully understood. The aim of this study was to investigate the influence of carbohydrate preoperative oral feeding on frequency and perforin expression in peripheral blood lymphocytes in patients after on- or off-pump CABG surgery in early postoperative period.
Patients And Methods:
In this prospective clinical study, 80 patients scheduled for CABG surgery were included in the study. The patients were randomly allocated into four groups (20 in each group): patients in Group 1 underwent on-pump CABG and did not receive carbohydrate preoperative oral feeding; patients in Group 2 underwent on-pump CABG and were preoperatively fed; patients in Group 3 underwent off-pump CABG and did not receive carbohydrate preoperative oral feeding; while patients in Group 4 underwent off-pump CABG and received carbohydrate preoperative oral feeding. Blood samples were collected immediately before (T1), 24 (T2) and 72 (T3) hours after the surgery. Peripheral blood mononuclear cells were isolated by gradient centrifugation and simultaneously labelled by antigens using fluorochrome-conjugated monoclonal antibodies. Frequency of T lymphocytes, NK and NKT cells, their subsets as well as their perforin expression were detected, and analyzed by flow cytometry.
Results:
There was significant decrease in frequency of CD3+ and CD3+CD4+ cells, as well as perforin expressing CD3+CD8+ cells in patients who underwent on-pump CABG in comparison to patients who underwent off-pump CABG 24 hours after the surgery. Carbohydrate preoperative oral feeding did not effect changes in lymphocytes subpopulations and perforin expression at any time point.
Conclusion:
Decreases of CD3+ cells on account of CD3+CD4+ subsets, and perforin expressing cells on account of CD3+CD8+ perforin+ cells were found in patients who had undergone on-pump CABG, but not in patients who had undergone off-pump CABG surgery, irrespectively of carbohydrate preoperative oral feeding.
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