Reduced expression of systemic proinflammatory and myocardial biomarkers after off-pump versus on-pump coronary artery bypass surgery: A prospective randomized study

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• 作者：Carlos V. Serrano Jr ; Juliana A. Souza ; Neuza H. Lopes ; Juliano L. Fern ; es ; José ; Carlos Nicolau ; Maria Heloí ; sa S.L. Blotta ; José ; Antô ; nio F. Ramires ; Whady A. Hueb
• 关键词：Cardiopulmonary bypass ; Troponin ; Inflammatory markers ; Off-pump heart surgery ; On-pump heart surgery ; C-reactive protein
• 刊名：Journal of Critical Care
• 出版年：2010
• 出版时间：June 2010
• 年：2010
• 卷：25
• 期：2
• 页码：305-312
• 全文大小：159 K

文摘

Background

The effects of off-pump (OffPCABG) and on-pump (OnPCABG) coronary artery bypass grafting (CABG) on myocardium and inflammation are unclear.

Objective

Compare the inflammatory response and myocardial injury from patients (pts) submitted to OffPCABG with those that undergo OnPCABG.

Methods

Patients with normal left ventricular function were assigned to OffPCABG (n = 40) and OnPCABG (n = 41). Blood samples were collected before and 24 hours after surgery for determination of creatine kinase (CK)–MB (CK-MB), troponin I (cTnI), interleukin (IL)–6, IL-8, P-selectin, intercellular adhesion molecule (ICAM)-1 and C-reactive protein (CRP). Mortalities were registered at 12 months.

Results

Preoperative CK-MB and cTnI levels were 3.1 ± 0.6 IU and 1.2 ± 0.5 ng/mL for OffPCABG and 3.0 ± 0.5 IU and 1.0 ± 0.2 ng/mL for OnPCABG pts. Postoperative CK-MB and cTnI levels were 13.9 ± 6.5 IU and 19.0 ± 9.0 ng/mL for OffPCABG vs 29.5 ± 11.0 IU and 31.5 ± 10.1 ng/mL for OnPCABG (P < .01). OffPCABG and OnPCABG pts had similar preoperative IL-6 (10 ± 7 and 9 ± 13 pg/mL), IL-8 (19 ± 7 and 17 ± 7 pg/mL), soluble P-selectin (70 ± 21 and 76 ± 23 pg/mL), soluble ICAM–1 (117 ± 50 and 127 ± 52 ng/mL), and CRP (0.09 ± 0.05 and 0.11 ± 0.07 mg/L). At 24 hours, for OffPCABG and OnPCABG: IL-6 was 37 ± 38* and 42 ± 41*^,† g/mL; IL-8, 33 ± 31* and 60 ± 15*^,† pg/mL; soluble P-selectin, 99 ± 26 and 172 ± 30*^,† pg/mL; soluble ICAM-1, 227 ± 47 and 236 ± 87*^,† ng/mL; and CRP, 10 ± 11* and 14 ± 13*^,† mg/L (*P < .01 vs preoperation; ^†P < .01 vs OffPCABG). Increased 24-hour postoperative CRP levels was the only marker to have significant positive correlations with events and occurred just for the OnPCABG pts. In-hospital and 1-year mortalities for the OnPCABG and OffPCABG pts were 2.0 % and 2.2 % (P = .1) and 2.7 % and 4.7 % (P = .06), respectively.

Conclusions

Thus, the absence of CPB during CABG preserves better the myocardium and attenuates inflammation—however, without improving survival.