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Published on: September 15, 2023
Comparative Analysis of Metabolomic Responses in On-Pump and Off-Pump Coronary Artery Bypass Grafting
Chananya Karunasumetta1, Wijittra Tourthong1, Rachata Mala1
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Purpose:
Although the clinical outcomes of on-pump (ONCAB) and off-pump CABG (OPCAB) are well established, their metabolomic impacts remain underexplored. This study aims to compare the metabolic profiles of ONCAB and OPCAB to identify differential metabolites associated with clinical outcomes.
Methods:
In a prospective cohort study conducted between January 2023 and September 2023, 100 plasma samples from 20 patients undergoing isolated elective CABG (10 per group) were analyzed. Samples were collected preoperatively and at multiple postoperative time points (Days 0-3) and processed using proton nuclear magnetic resonance (1H-NMR). Advanced statistical modeling was applied to identify differential metabolites.
Results:
No significant differences were found in clinical outcomes, although ONCAB showed higher postoperative CKMB levels. Both procedures induced metabolomic alterations, with ONCAB demonstrating a more substantial impact, particularly on Day 0. Key metabolites, including leucine, succinate, creatine, glucose, and adenine, affected starch and sucrose metabolism.
Conclusion:
ONCAB induces more pronounced metabolic shifts immediately postsurgery, involving protein and energy turnover, oxidative stress, and disrupted glucose metabolism, indicative of cellular stress responses. A comprehensive understanding of these metabolic changes is critical for informing targeted interventions and supports the use of OPCAB as a preferred strategy for patients with elevated metabolic risks.
Insights
On-pump coronary artery bypass grafting (ONCAB) causes greater immediate metabolic changes than off-pump coronary artery bypass grafting (OPCAB). These changes involve protein, energy, and glucose metabolism, suggesting higher cellular stress with ONCAB.
Area of Science:
- Cardiovascular Surgery
- Metabolomics
- Biochemistry
Background:
- Clinical outcomes of on-pump (ONCAB) and off-pump coronary artery bypass grafting (OPCAB) are established.
- The metabolomic impacts of ONCAB versus OPCAB are not well understood.
Purpose of the Study:
- To compare the metabolic profiles of ONCAB and OPCAB.
- To identify differential metabolites associated with clinical outcomes in CABG patients.
Main Methods:
- Prospective cohort study of 20 patients undergoing isolated elective CABG (10 ONCAB, 10 OPCAB).
- Plasma samples collected preoperatively and postoperatively (Days 0-3).
- Proton nuclear magnetic resonance (1H-NMR) spectroscopy and advanced statistical modeling used for metabolite analysis.
Main Results:
- No significant differences in overall clinical outcomes between ONCAB and OPCAB.
- ONCAB group showed higher postoperative CKMB levels.
- Both procedures altered metabolomic profiles, with ONCAB inducing more significant changes on postoperative Day 0.
- Key metabolites affected included leucine, succinate, creatine, glucose, and adenine, impacting starch and sucrose metabolism.
Conclusions:
- ONCAB leads to more pronounced immediate metabolic shifts post-surgery compared to OPCAB.
- Metabolic changes involve protein and energy turnover, oxidative stress, and disrupted glucose metabolism, indicating cellular stress.
- Understanding these metabolic differences is crucial for targeted interventions; OPCAB may be preferred for patients with high metabolic risks.
