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Off-pump coronary artery bypass grafting attenuates proinflammatory markers

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The Japanese Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective: Cardiac surgery with cardiopulmonary bypass (CPB) has been considered the main causative factors of postoperative inflammatory reactions. The aim of this study was to compare surrogate markers of the proinflammatory response in patients who underwent coronary artery bypass grafting (CABG) with or without CPB. Methods and Results: Twenty patients undergoing first-time CABG were enrolled in the study, 10 with and 10 without CPB. Blood samples were drawn at the following times: at the anesthetic induction, the end of surgery, and thereafter at 12 and 24 hours postoperatively. Neutrophil elastase, interleukin (IL)-6 , and serum soluble Fas were chosen to evaluate the extent of the systemic inflammatory response. The groups were similar in terms of age, gender ratio, number of grafts per patient. There were no operative mortality or serious postoperative complications. Two of each group received blood transfusion postoperatively. Neutrophil elastase showed a significantly higher value in the on-pump group compared with the off-pump group at the end of surgery. Soluble Fas level showed a higher value at the end of surgery compared with baseline, while it had no significant changes in the off-pump patients. IL-6 levels in the on-pump group were consistently higher compared to the off-pump group but showed no statistically significant differences between the groups. Conclusion: Compared with off-pump CABG, on pump CABG induced higher serum levels of proinflammatory markers including neutrophil elastase and soluble Fas.

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References

  1. Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 552–9.

    Article  PubMed  CAS  Google Scholar 

  2. Asimakopoulos G, Taylor KM. Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules. Ann Thorac Surg 1998; 66: 2135–44.

    Article  PubMed  CAS  Google Scholar 

  3. Butler J, Parker D, Pillai R, Westaby S, Shale DJ, Rocker GM. Effect of cardiopulmonary bypass on systemic release of neutrophil elastase and tumor necrosis factor. J Thorac Cardiovasc Surg 1993; 105: 25–30.

    PubMed  CAS  Google Scholar 

  4. Wan S, Izzat MB, Lee TW, Wan IY, Tang NL, Yim AP. Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. Ann Thorac Surg 1999; 68: 52–7.

    Article  PubMed  CAS  Google Scholar 

  5. Brasil LA, Gomes WJ, Salomao R, Buffolo E. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 56–9.

    Article  PubMed  CAS  Google Scholar 

  6. Chello M, Mastroroberto P, Quirino A, Cuda G, Perticone F, Cirillo F, et al. Inhibition of neutrophil apoptosis after coronary bypass operation with cardiopulmonary bypass. Ann Thorac Surg 2002; 73: 123–9.

    Article  PubMed  Google Scholar 

  7. Biffl WL, Moore EE, Moore FA, Barnett CC Jr, Carl VS, Peterson VM. Interleukin-6 delays neutrophil apoptosis. Arch Surg 1996; 131: 24–30.

    PubMed  CAS  Google Scholar 

  8. Leuenroth S, Lee C, Grutkoski P, Keeping H, Simms HH. Interleukin-8-induced suppression of polymorphonuclear leukocyte apoptosis is mediated by suppressing CD95 (Fas/Apo-1) Fas-1 interactions. Surgery 1998; 124: 409–17.

    PubMed  CAS  Google Scholar 

  9. Fanning NF, Porter J, Shorten GD, Kirwan WO, Bouchier-Hayes D, Cotter TG, et al. Inhibition of neutrophil apoptosis after elective surgery. Surgery 1999; 126: 527–34.

    PubMed  CAS  Google Scholar 

  10. Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomized controlled trials. Lancet 2002; 359: 1194–9.

    Article  PubMed  Google Scholar 

  11. Cleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001; 72: 1282–9.

    Article  PubMed  Google Scholar 

  12. Magee MJ, Jablonski KA, Stamou SC, Pfister AJ, Dewey TM, Dullum MK, et al. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 2002; 73: 1196–203.

    Article  PubMed  Google Scholar 

  13. Riegel W, Spillner G, Schlosser V, Horl WH. Plasma levels of main granulocyte components during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1988; 95: 1014–9.

    PubMed  CAS  Google Scholar 

  14. Faymonville ME, Pincemail J, Duchateau J, Paulus JM, Adam A, Deby-Dupont G, et al. Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans. J Thorac Cardiovasc Surg 1991; 102: 309–17.

    PubMed  CAS  Google Scholar 

  15. Yoshimura T, Matsushima K, Tanaka S, Robinson EA, Appella E, Oppenheim JJ, et al. Purification of a human monocyte-derived neutrophil chemotactic factor that has peptide sequence similarity to other host defense cytokines. Proc Natl Acad Sci USA 1987; 84: 9233–7.

    Article  PubMed  CAS  Google Scholar 

  16. Kawahito K, Kawakami M, Fujiwara T, Adachi H, Ino T. Interleukin-8 and monocyte chemotactic activating factor responses to cardiopulmonary bypass. J Thorac Cardiovasc Surg 1995; 110: 99–102.

    Article  PubMed  CAS  Google Scholar 

  17. Kawahito K, Kobayashi E, Ohmori M, Harada K, Kitoh Y, Fujimura A, et al. Enhanced responsiveness of circulatory neutrophils after cardiopulmonary bypass: Increased aggregability and superoxide producing capacity. Artif Organs 2000; 24: 37–42.

    Article  PubMed  CAS  Google Scholar 

  18. Yonehara S, Ishii A, Yonehara M. A cell-killing monoclonal antibody (anti-Fas) to a cell surface antigen co-downregulated with the receptor of tumor necrosis factor. J Exp Med 1989; 169: 1747–56.

    Article  PubMed  CAS  Google Scholar 

  19. Itoh N, Yonehara S, Ishii A, Yonehara M, Mizushima S, Sameshima M, et al. The polypeptide encoded by the cDNA for human cell surface antigen Fas can mediate apoptosis. Cell 1991; 66: 233–43.

    Article  PubMed  CAS  Google Scholar 

  20. Tomokuni A, Aikoh T, Matsuki T, Isozaki Y, Otsuki T, Kita S, et al. Elevated soluble Fas/APO-1 (CD95) levels in silicosis patients without clinical symptoms of autoimmune disease or malignant tumors. Clin Exp Immunol 1997; 110: 303–9.

    Article  PubMed  CAS  Google Scholar 

  21. Tokano Y, Miyake S, Koyagaki N, Nozawa K, Morimoto S, Azuma M, et al. Soluble Fas molecule in the serum of patients with systemic lupus erythematosus. J Clin Immunol 1996; 16: 261–5.

    Article  PubMed  CAS  Google Scholar 

  22. Adamopoulos S, Parissis J, Karatzas D, Kroupis C, Georgiadis M, Karavolias G, et al. Physical training moderates proinflammatory cytokines and the soluble Fas/soluble Fas ligand system in patients with chronic heart failure. J Am Coll Cardiol 2002; 39: 653–63.

    Article  PubMed  CAS  Google Scholar 

  23. Toyozaki T, Hiroe M, Saito T, Iijima Y, Takano H, Hiroshima K, et al. Levels of soluble Fas in patients with myocarditis, heart failure of unknown origin, and in healthy volunteers. Am J Cardiol 1998; 81: 798–800.

    Article  PubMed  CAS  Google Scholar 

  24. Kawahito K, Misawa Y, Fuse K. Transient rise in serum soluble Fas (APO-1/CD95) in patients undergoing cardiac surgery. Artif Organs 2000; 24: 628–31.

    Article  PubMed  CAS  Google Scholar 

  25. Jimenez MF, Watson RW, Parodo J, Evans D, Foster D, Steinberg M, et al. Dysregulated expression of neutrophil apoptosis in the systemic inflammatory response syndrome. Arch Surg 1997; 132: 1263–70.

    PubMed  CAS  Google Scholar 

  26. Matata BM, Sosnowski AW, Galinanes M. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg 2000; 69: 785–91.

    Article  PubMed  CAS  Google Scholar 

  27. Kilger E, Pichler B, Weis F, Goetz A, Lamm P, Schutz A, et al. Markers of myocardial ischemia after minimally invasive and conventional coronary operation. Ann Thorac Surg 2000; 70: 2023–8.

    Article  PubMed  CAS  Google Scholar 

  28. Fransen E, Maessen J, Dentener M, Senden N, Geskes G, Buurman W. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest 1998; 113: 1290–5.

    PubMed  CAS  Google Scholar 

  29. Tarnok A, Hambsch J, Emmrich F, Sack U, van Son J, Bellinghausen W, et al. Complement activation, cytokines, and adhesion molecules in children undergoing cardiac surgery with or without cardiopulmonary bypass. Pediatr Cardiol 1999; 20: 113–25.

    Article  PubMed  CAS  Google Scholar 

  30. Diegeler A, Doll N, Rauch T, Haberer D, Warmer T, Falk V, et al. Humoral immune response during coronary artery bypass grafting: A comparison of limited approach, “off-pump” technique, and conventional cardiopulmonary bypass. Circulation 2000; 102 (19 Suppl 3):III–95-100.

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Kyorin University, Tokyo, Japan

    Hidehito Endo MD

  2. Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma, Omiya-ku, 330-8503, Saitama, Japan

    Atsushi Yamaguchi MD, Hidehito Endo MD, Koji Kawahito MD, Hideo Adachi MD & Takashi Ino MD

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  1. Atsushi Yamaguchi MD
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  2. Hidehito Endo MD
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  3. Koji Kawahito MD
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  4. Hideo Adachi MD
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  5. Takashi Ino MD
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Yamaguchi, A., Endo, H., Kawahito, K. et al. Off-pump coronary artery bypass grafting attenuates proinflammatory markers. Jpn J Thorac Caridovasc Surg 53, 127–132 (2005). https://doi.org/10.1007/s11748-005-0017-7

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  • DOI: https://doi.org/10.1007/s11748-005-0017-7

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