Off-pump coronary artery bypass graft (CABG) surgery may reduce the inflammatory response and the neuronal damage associated with conventional CABG on cardio-pulmonary bypass. The purpose of this study was to explore the protective effect of off-pump surgery by assessing plasma inflammatory and neuronal injury markers. Forty-one patients with coronary artery disease undergoing elective CABG were examined: 21 on-pump (Group I) and 20 off-pump (Group II). The perioperative release of interleukin-2 receptor (IL-2r), IL-6, tumor necrosis factor-alpha, S-100 protein (S-100) and neuron-specific enolase (NSE) were measured. Postoperative peak values of NSE (p B /0.001) and S-100 (p B /0.05) were significantly lower in Group II. IL-6 showed significantly lower values in off-pump patients (p B /0.001). A significant correlation was found between NSE and IL-6 (p B /0.001). In conclusion, off-pump surgery reduces the inflammatory response as well as the perioperative release of neuronal damage markers. Correlation between inflammatory activation and neuronal markers may suggest a link between inflammation and release of markers of neuronal clinical and subclinical injury.
Get full access to this article
View all access options for this article.
References
1.
Gu YJ , Mariani MA , van Oeveren Wet al.Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting . Ann Thorac Surg1998; 65: 420-424 .
2.
Taylor KM.SIRS: the systemic inflammatory response syndrome after cardiac operations . Ann Thorac Surg1996; 61: 1607-1608 .
3.
Fransen EJ , Maessen JG , Hermens WT , Glatz JF , Buurman WA.Peri-operative myocardial tissue injury and the release of the inflammatory mediators in coronary artery bypass graft patients . Cardiovasc Res2000; 45: 853-859 .
4.
Sablotzki A , Dehne MG , Mann Vet al.Plasma levels of selectins and interleukins in cardiovascular surgery using cardiopulmonary bypass . Thorac Cardiovasc Surg1999; 47: 26-31 .
5.
Wan S , Izzat MB , Lee TW , Wan YI , Tang NL , Yim AP.Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury . Ann Thorac Surg1999; 68: 52-57 .
6.
Borowicz L , Goldsborough M , Selnes O , McKhanm GM.Neuropsychologic change after cardiac surgery: a critical review . J Cardiothorac Vasc Anesth1996; 10: 105-112 .
7.
Persson L , Hardemark HG , Gustafsson Jet al.S-100 protein and neuron-specific enolase in cerebrospinal fluid and serum: markers of all damage in human central nervous system . Stroke1987; 18: 911-918 .
8.
Barone FC , Clarke RK , Price WJet al.NSE increases in cerebral and systemic circulation following focal ischemia . Brain Res1993; 623: 77-82 .
9.
Herrmann M , Ebert AD , Galazky Iet al.Neurobehavioral outcome prediction after cardiac surgery. Role of neurobiochemical markers of damage to neuronal and glial brain tissue . Stroke2000; 31: 645-650 .
10.
Ashraf S , Bhattacharya K , Tian Y , Watterson K.Cytokine and S-100B levels in paediatric patients undergoing corrective cardiac surgery with or without total circulatory arrest . Eur J Cardiothorac Surg1999; 16: 32-37 .
11.
Diegeler A , Hirsch R , Schneider Fet al.Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation . Ann Thorac Surg2000; 69: 1162-1166 .
12.
Braegger CP , Nicholls S , Murch SH , Savage MO , Walker-Smith JA , MacDonald TT.Tumor necrosis factor alpha in stool as a marker of intestinal inflammation . Lancet1992; 339: 89-91 .
13.
Taniguchi T , Minami J.The IL-2/IL-2r system: a current overview . Cell1993; 73: 5-8 .
14.
Hirano T , Akira S , Taga T , Kishimoto T.Biological and clinical aspects of interleukin 6 . Immunol Today1990; 11: 443-449 .
15.
Bonfrer JMG.The luminescence immunoassay S-100B: a sensitive test to measure circulating S-100B . Br J Cancer1998; 77: 2210-2214 .
16.
Fitch J , Rollins S , Matis Let al.Pharmacology and biological efficacy of a recombinant humanized, single-chain antibody C5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass . Circulation1999; 100: 2499-2506 .
17.
Grieco G , d’Hollosy M , Culliford A , Jonas S.Evaluating neuroprotective agents for clinical anti-ischemic benefit using neurological and neuropsychological changes after cardiac surgery under CPB . Stroke1996; 27: 858-874 .
18.
Wanschneider W , Thalmann M , Trampitsch E , Ziervogel G , Kobinia G.Off-pump coronary bypass operations significantly reduce S100 release: an indicator for less cerebral damage?Ann Thorac Surg2000; 70: 1577-1579 .
19.
Jonsson H , Johnsson P , Alling C , Backstrom M , Bergh C , Blomquist S.S100 after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome . Ann Thorac Surg1999; 68: 2202-2208 .
20.
Matata BM , Sosnowski A , Galinanes M.Off-pump bypass graft operation significantly reduces oxidative stress and inflammation . Ann Thorac Surg2000; 69: 785-791 .
21.
Sawa Y , Ichikawa H , Kagisaki K , Ohata T , Matsuda H.IL-6 derived from hypoxic myocytes promotes neutro-phil-mediated reperfusion injury in myocardium . J Thorac Cardiovasc Surg1998; 116: 511-517 .
