title: Higher levels of serum cytokines and myocardial tissue markers during on-pump versus off-pump coronary artery bypass surgery.
abstract: Increased Troponin I levels and pro-inflammatory cytokines have been reported in most patients undergoing cardiac surgery, ascribed to the type and extent of surgery, reperfusion injury, and the method of myocardial protection. We investigated their levels in patients undergoing on-pump (CCAB) or off-pump (OPCAB) coronary artery bypass surgery and whether these correlated with the extent of myocardial injury. One hundred twenty patients were prospectively randomized to undergo OPCAB (n = 60) or CCAB (n = 60). Hemodynamic and respiratory data, as well as serum CK-MB mass fraction, Troponin I, and interleukin (IL)-6, IL-8, and IL-10 levels, were collected perioperatively. Demographic, hemodynamic, and respiratory parameters were similar between the two groups. Troponin I was significantly lower in the OPCAB than in the CCAB group, either at the end of ischemia, end of surgery, 6-hour and 24-hour postoperatively (4 +/- 3, 5 +/- 3, 7 +/- 5, and 8 +/- 3 microg/L, vs. 19 +/- 18, 27 +/- 19, 28 +/- 13.5, and 33 +/- 8.5 microg/L, respectively, p < 0.05). Serum cytokine levels in the OPCAB patients were lower compared to the CCAB group at the end of surgery (32 +/- 35, 25 +/- 30, and 40 +/- 30 pg/ml for IL-6, IL-8, and IL-10 vs. 230 +/- 30, 140 +/- 70, and 125 +/- 50 pg/ml, respectively, p < 0.05). Plasma IL-6 levels correlated with the Troponin I levels at the end of surgery in both groups (r = 0.45, p = 0.01). Thus, OPCAB surgery is associated with reduced levels of Troponin I and activation of cytokines, compared to those in the CCAB group. High levels of these factors could correlate with myocardial damage during coronary artery bypass surgery. This finding warrants further laboratory and clinical confirmation in the future.
authors.affiliation: Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. nachumnesher@yahoo.com
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.forename: Ina
authors.initials: I
authors.lastname: Frolkis
authors.forename: Moshe
authors.initials: M
authors.lastname: Vardi
authors.forename: Nechama
authors.initials: N
authors.lastname: Sheinberg
authors.forename: Ihsan
authors.initials: I
authors.lastname: Bakir
authors.forename: Filip
authors.initials: F
authors.lastname: Caselman
authors.forename: Demitri
authors.initials: D
authors.lastname: Pevni
authors.forename: Yanay
authors.initials: Y
authors.lastname: Ben-Gal
authors.forename: Ram
authors.initials: R
authors.lastname: Sharony
authors.forename: Gil
authors.initials: G
authors.lastname: Bolotin
authors.forename: Dan
authors.initials: D
authors.lastname: Loberman
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000097:blood / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D019210:Troponin I; D016753:Interleukin-10; D052279:Creatine Kinase, MB Form