Off-pump Coronary Artery Bypass Does Not Influence Biomarkers of Brain Injury, But Does Exacerbate the Systemic Inflammatory Response

Abstract

Background: The protective effects of off-pump (OPCAB) compared to conventional (CCAB) coronary artery bypass graft surgery on neurological injury and inflammation has been controversial. We evaluated pre-and postoperative levels of the brain injury marker, S100β, and markers of inflammation, Interleukin-6 (IL-6) and high sensitivity C-reactive protein (hs-CRP) in a prospective randomized controlled trial. Methods:A sub-group sample of the randomized controlled trial of 50 consecutive randomized patients (n=27 CCAB, n=23 OPCAB) was utilized for the present biomarker analysis. Each patient had blood drawn before and after surgery. Analysis of variance and Kruskal-Wallis were used to assess significant differences in biomarkers.Results: There was no difference in post-procedure S100β (p=0.1) or change in S100β from baseline (p=0.9). Hs-CRP and IL-6 were higher in the OPCAB arm post-procedure (P CRP =0.001; P IL-6 =0.053) and change from baseline (P CRP =0.003; P IL-6 =0.001). Conclusion:OPCAB did not result in preventing neurological injury over CCAB; however, OPCAB had significantly more inflammation than CCAB following the procedure.

Effects of Vasodilation and Arterial Resistance on Cardiac Output

“…Therefore, dilation of arteries and arterioles leads to an immediate decrease in arterial blood pressure and heart rate (hence, chemical arterial dilators are used to treat heart failure, systemic and pulmonary hypertension, and angina) [55]. At times leads to respiratory problems [56]. The response may be intrinsic (due to local processes in the surrounding tissue) or extrinsic (due to hormones or the nervous system).…”

Specific, Robust, Reproducible: The Hunt for the Ideal Biomarker

“…The authors compared expression of inflammation markers Interleukin-6 and high sensitivity C6 reactive protein (hs-CRP) following conventional coronary artery bypass graft surgery (CCAB) and off-pump coronary artery bypass graft surgery (OPCAB). The data demonstrate that patients, who were operated using OPCAB technique, showed increased systemic inflammation response compared to the patients who underwent conventional artery bypass graft surgery [7].…”

“…The authors identified the chemokine (C-X3-C motif) receptor 1 (CX3CR1) as a novel biomarker that was significantly increased in the patients with favorable outcome [6]. The example how already known biomarkers can be used to compare different surgical techniques for their safety and/or occurrence of adverse events was demonstrated by Brown et al [7]. The authors compared expression of inflammation markers Interleukin-6 and high sensitivity C6 reactive protein (hs-CRP) following conventional coronary artery bypass graft surgery (CCAB) and off-pump coronary artery bypass graft surgery (OPCAB).…”

Assessment & Effectiveness of Surgeries in Human Safety

“…For instance, repairs of congenital heart defects are currently estimated to have very mortality rates. The development of cardiac [37] surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low ranks. For instance, repairs of congenital heart defects are currently estimated to have very few mortality rates.…”