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Changes of leukocyte subsets in coronary artery bypass surgery: cardiopulmonary bypass versus 'off-pump' techniques
A Diegeler1, A Tárnok, T Rauch
1Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany.
Insights
Coronary bypass surgery, with or without cardiopulmonary bypass (CPB), causes similar changes in leukocyte subsets. The immune response appears primarily linked to surgical trauma rather than CPB itself.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Surgical Outcomes
Background:
- Cardiopulmonary bypass (CPB) in coronary bypass grafting (CABG) is linked to systemic inflammation.
- Off-pump CABG techniques aim to mitigate CPB's adverse effects.
- The specific impact of CPB on immune cells requires further investigation.
Purpose of the Study:
- To investigate changes in leukocyte subsets during and after CABG.
- To compare immune cell responses in on-pump CABG, off-pump CABG, and minimally invasive off-pump CABG.
Main Methods:
- Studied leukocyte subsets in three groups: on-pump CABG (n=10), off-pump CABG (n=10), and minimally invasive off-pump LAD bypass (n=10).
- Monitored circulating blood leukocyte subsets during and after surgery.
Main Results:
- Leukocyte subset changes were similar across all three surgical groups.
- Leukocyte counts increased post-reperfusion in the CPB group, with a delayed rise in off-pump groups.
- Lymphocyte and T-lymphocyte subsets showed similar patterns, including a postoperative drop in T4-helper cells.
Conclusions:
- Leukocyte subset reactions to CABG are primarily associated with general surgical trauma.
- CPB does not appear to be the main driver of observed immune cell changes in this context.
Background:
The use of cardiopulmonary bypass (CPB) in coronary bypass grafting is associated with a generalized inflammatory response. This negative impact of CPB may be avoided by using new surgical techniques recently introduced to perform coronary bypass grafting 'off-pump', i.e. without CPB.
Methods:
Since the specific effects of CPB on the immunorelevant cells have still not been fully investigated, we measured the changes in leukocyte subsets of the circulating blood in patients who underwent coronary bypass surgery with a conventional sternotomy approach and CPB (group A, n = 10), in patients who underwent the same surgical procedure but without CPB (group B, n = 10), and in patients who underwent a minimally invasively performed single bypass to the left anterior descending artery (LAD) (group C, n = 10).
Results:
Leukocyte subsets showed a similar change during and after coronary bypass grafting in all three groups. The total number of leukocytes was increased soon after reperfusion in the CPB group. A similar but delayed increase was observed in both off-pump groups. Changes in lymphocyte subsets and T-lymphocyte subsets were similar in all three groups, with a drop of lymphocytes during the first 24 postoperative hours mainly caused by a drop of T4-helper cells.
Conclusion:
The results indicate a reaction of the leukocyte subsets to coronary bypass surgery which is more related to the surgical trauma in general than to CPB in particular.