Changes in Vascular Cell Adhesion Molecule-1 in Conventional Versus Robotic Bypass Graft Surgery

Elevated plasma levels of vascular cell adhesion molecule-1 (VCAM-1) are implicated in cardiovascular complications after cardiac surgery. This study investigated changes in circulating VCAM-1 levels during robotic-assisted coronary artery bypass graft (R-CABG) compared to conventional coronary artery bypass graft (C-CABG).

Fifty-seven patients were divided into C-CABG (n = 27) and R-CABG (n = 30) groups. The R-CABG group was further stratified into those with extracorporeal membrane oxygenation (ECMO) (n = 14) and those without ECMO (n = 16). Plasma VCAM-1 levels were measured preoperatively (Pre-OP), intraoperatively (Intra-OP), and postoperatively (Post-OP). Surgical risk was assessed using the EuroSCORE II.

Post-OP plasma VCAM-1 levels were significantly higher in the C-CABG group when compared to R-CABG group (1807.84 ± 710.74 versus 1320.56 ± 481.28 ng/mL, P = 0.007). Subgroup analysis indicated no significant differences in VCAM-1 levels between R-CABG patients with and without ECMO. Pre-OP VCAM-1 levels correlated positively with EuroSCORE II (r = 0.503, P < 0.001). R-CABG was associated with significantly lower Post-OP atrial fibrillation (AFib) rates. Patients who developed AFib showed persistently higher VCAM-1 levels, and Pre-OP VCAM-1 was a predictor of Post-OP AFib, with an area under the curve (AUC) of 0.741 (95% confidence interval [CI]: 0.608-0.848, P = 0.003).

R-CABG results in significantly lower postoperative VCAM-1 levels than C-CABG; however, this finding should be interpreted with caution, as most C-CABG patients had three-vessel coronary artery disease, whereas most R-CABG patients had single-vessel coronary artery disease. This robotic approach may reduce cardiovascular complications linked to elevated VCAM-1. Preoperative VCAM-1 may be a useful biomarker for assessing mortality risk and predicting postoperative AFib in CABG patients.