Off-pump coronary artery bypass attenuates transient hepatocellular damage after myocardial revascularization.
OBJECTIVE
Cardiopulmonary bypass (CPB) affects hepatocellular integrity and occasionally results in liver dysfunction after cardiac surgery. Performing coronary artery bypass graft surgery without CPB may help to reduce the risk of this complication and better preserve perioperative liver function. This study compared perioperative hepatocellular damage in patients undergoing on-pump and off-pump bypass surgery.


METHODS
Prospective study.


METHODS
University hospital.


METHODS
Patients scheduled for elective on-pump (n = 21) and off-pump (n = 17) coronary artery bypass surgery.


RESULTS
Liver function was assessed by serum levels of alcohol dehydrogenase (AD) and alpha-glutathione S-transferase (alpha-GST), which serve as more sensitive indices of hepatocellular injury than do conventional transaminases. Arterial blood was sampled at 6 stages: after induction of anesthesia (baseline); at the end of CPB in the on-pump group or on completion of the last distal anastomosis in the off-pump group; at the end of surgery; and 6 hours, 12 hours, and 24 hours after the end of anesthesia. The off-pump patients showed significantly lower increases in serum AD and alpha-GST levels than did the on-pump group. AD and alpha-GST values increased in the on-pump patients after the initiation of CPB and peaked at the end of surgery, with a return to baseline at 12 hours and 24 hours after the end of anesthesia. No clinically relevant liver dysfunction was observed in either group.


CONCLUSIONS
CPB induced transient subclinical hepatocellular damage, whereas off-pump revascularization attenuated this damage.
Yamada
Tatsuya
T
Department of Anesthesiology, School of Medicine, Keio University, 35 Shinanoma-chi, Shinjuku-hu, Tokyo, Japan. koanes@sc.itc.keio.ac.jp
Ochiai
Ryoichi
R
Takeda
Junzo
J
Kikuchi
Haruhito
H
Ishibashi
Midori
M
Watanabe
Kiyoaki
K
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000426:Alcohol Dehydrogenase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005982:Glutathione Transferase / Q000097:blood; D006527:Hepatolenticular Degeneration / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000426:Alcohol Dehydrogenase; D005982:Glutathione Transferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase