Decrease of Perforin Expressing Lymphocytes after On-Pump Coronary Artery Bypass Grafting Surgery Irrespective of Carbohydrate Preoperative Oral Feeding

Abstract

<jats:p>Background: Coronary artery bypass grafting (CABG) surgery continues to be the gold standard for treating the patients with coronary artery disease. CABG surgery can be performed on or off cardiopulmonary bypass, termed as on-pump or off-pump CABG, respectively. It has been shown that CABG surgery, preferably on-pump CABG surgery, leads to the changes of cell immunity during perioperative and early postoperative period. The mechanisms of regulation of the immune response in patients during and early after surgical revascularization are not fully understood. &#x0D; The aim of this study was to investigate the influence of carbohydrate preoperative oral feeding on frequency and perforin expression in peripheral blood lymphocytes in patients after on- or off-pump CABG surgery in early postoperative period. &#x0D; Patients and methods: In this prospective clinical study, 80 patients scheduled for CABG surgery were included in the study. The patients were randomly allocated into four groups (20 in each group): patients in Group 1 underwent on-pump CABG and did not receive carbohydrate preoperative oral feeding; patients in Group 2 underwent on-pump CABG and were preoperatively fed; patients in Group 3 underwent off-pump CABG and did not receive carbohydrate preoperative oral feeding; while patients in Group 4 underwent off-pump CABG and received carbohydrate preoperative oral feeding. Blood samples were collected immediately before (T1), 24 (T2) and 72 (T3) hours after the surgery. Peripheral blood mononuclear cells were isolated by gradient centrifugation and simultaneously labelled by antigens using fluorochrome-conjugated monoclonal antibodies. Frequency of T lymphocytes, NK and NKT cells, their subsets as well as their perforin expression were detected, and analyzed by flow cytometry.&#x0D; Results: There was significant decrease in frequency of CD3+ and CD3+CD4+ cells, as well as perforin expressing CD3+CD8+ cells in patients who underwent on-pump CABG in comparison to patients who underwent off-pump CABG 24 hours after the surgery. Carbohydrate preoperative oral feeding did not effect changes in lymphocytes subpopulations and perforin expression at any time point. &#x0D; Conclusion: Decreases of CD3+ cells on account of CD3+CD4+ subsets, and perforin expressing cells on account of CD3+CD8+ perforin+ cells were found in patients who had undergone on-pump CABG, but not in patients who had undergone off-pump CABG surgery, irrespectively of carbohydrate preoperative oral feeding.</jats:p>

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

“…Altogether, nine studies ( N = 9) were included [ 45 , 47 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] comprising 11 interventions. However, as mentioned previously, two studies comprised the same study group and presented similar results in separate papers, thus the numbers of studies and interventions are 8 and 10, respectively.…”

“…In the majority of studies [ 45 , 47 , 54 , 55 , 56 , 57 , 58 ], 12.5% oral carbohydrate (OCH) solution was used. In two studies, 12.8% [ 59 ] and 12.6% [ 60 ] OCH was ingested. Patients received a different amount of OCH drink, varying from 200 to 1200 mL, either once before the surgery or at various times.…”

“…Patients received a different amount of OCH drink, varying from 200 to 1200 mL, either once before the surgery or at various times. The most frequent comparator in the studies included into the qualitative synthesis was fasting [ 45 , 47 , 57 , 58 , 59 , 60 ]. In three trials (including a duplicate study by Feguri et al 2017 and Feguri et al 2019), patients received water instead of OCH load [ 54 , 55 , 56 ].…”

“…In the majority of studies, coronary artery bypass grafting with cardio-pulmonary bypass and general anesthesia with endotracheal intubation was performed [ 45 , 47 , 54 , 55 , 56 , 57 , 58 ]. A subgroup of patients in a study by Sokolic et al [ 60 ] underwent off-pump coronary artery bypass grafting (OPCAB). In a study by Lee et al [ 59 ], OPCAB revascularization was also performed.…”

“…Only one study scored high risk for allocation concealment (selection bias) and blinding of participants and personnel (performance bias) [ 57 ]. The highest number of domains (four) assessed as unclear risk of bias was obtained by four studies [ 45 , 47 , 58 , 60 ]. The risk of bias assessments for each study (listed in Table 1 ) is presented in Supplemental Table S1 Study and patients’ characteristics are shown in Table 1 .…”