Off-Pump Revascularization Reduces Endothelial Activation, Myocardial Injury Following Cardiac Surgery

Off-pump revascularisation can result in reduced endothelial activation and myocardial injury during coronary artery bypass, say Finnish researchers.

Dr Matti Taikka and colleagues at Tampere’s University Hospital acknowledged that one of the major complex systemic inflammatory responses, following cardiac surgery, is due to cardiopulmonary bypass. Central to this was leukocyte-endothelial binding followed by neutrophil migration and these interactions, they explained, are mediated by adhesion molecules on the surface of activated cells.

Consequently, the researchers recruited 20 patients scheduled for coronary artery bypass grafting to compare the perioperative levels of soluble adhesion molecules following surgery, regardless of whether they underwent a cardiopulmonary bypass.

Nine patients were assigned to off-pump revascularization and 11 patients underwent cardiopulmonary bypass (CPB).

Plasma levels of soluble adhesion molecules sE-selectin and sP-selectin and soluble intercellular adhesion molecule-1 (sICAM-1) were measured prior to anaesthesia induction, and at 1, 4 and 20 hours following reperfusion to the myocardium.

The two groups experienced similar baseline plasma levels of adhesion molecules. There was no difference either between the groups in the perioperative levels of sE-selectin, which also remained the same. However, the plasma sP selectin increased in both groups, with a significantly greater increase in the CPB group by comparison with those who underwent off pump revascularization.

The researchers noted that plasma sICAM-1 decreased during an early stage following coronary artery bypass with CPB, but recovery occurred four hours after reperfusion. This was followed 20 hours later by a significant increase in ICAM-1.

There was no alteration in the sICAM-1 at 1 and 4 hours, but an increase was noted 20 hours later in the off-pump group.

Creatinine kinase-muscle bound levels were significantly higher postoperatively in the cardiopulmonary by pass compared to those in the off pump group and a correlation was also noted between the change in the sP-selectin levels and creatinine kinase-muscle bound values.

World Journal of Surgery 2003;DOI 10.1007/s00268-002-6595-y.