Key result
On-pump CABG is linked to greater intraoperative increases in inflammatory markers than off-pump CABG.
Why the study?
Cardiac surgeries induce inflammatory responses with clinical implications, and plasma Trp/Kyn ratio is used to measure inflammatory cytokine activity, but differences between on- and off-pump CABG are not well characterized.
Does off-pump CABG reduce the systemic inflammatory response compared to on-pump CABG in patients undergoing coronary revascularization?
Observational (n=62)
No
Does off-pump CABG reduce the systemic inflammatory response compared to on-pump CABG in patients undergoing coronary revascularization?
Off-pump CABG is associated with a less severe systemic inflammatory response compared to on-pump CABG, as measured by the tryptophan/kynurenine pathway and standard inflammatory markers.
Should not yet change CABG technique selection; leaves open whether inflammatory differences affect outcomes.
Background: Cardiac surgeries induce many inflammatory responses with remarkable clinical implications. Tryptophan (Trp) is a precursor for serotonin, melatonin and kynurenine (Kyn). Plasma kynurenic acid (Kyna) and Kyn concentrations are thought to be related to the severity of inflammation. Plasma Trp/Kyn ratio is used to measure inflammatory cytokine activity.Methods: We performed the current longitudinal study in a tertiary care center and included 62 patients divided into two groups; group A (on-pump CABG patients) and group B (off-pump CABG patients). Plasma Trp and Kyn were measured using the high-performance liquid chromatography (HPLC) technique. Serum interlukin-6 (IL-6) and white blood cells (WBCs) were measured using ELISA and routine blood count, respectively.Results: The present study revealed that the intraoperative levels of plasma Kyn, IL-6 and WBCs were significantly increased while the plasma Trp/Kyn ratio was significantly decreased in both the groups; however, the changes were more significant in the on-pump CABG group. Moreover, the levels in both the groups returned to preoperative levels 72 h postoperative. Our study has shown that WBCs is positively correlated with IL-6, but has negative correlation with Trp/Kyn ratio.Conclusions: Kyn and Trp/Kyn ratio might be utilized as markers of the severity of inflammation in major surgery. In addition, off-pump CABG might be more preferable than on-pump CABG regarding stress and release of inflammatory markers.
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Farouk et al. (2022) conducted an observational in Coronary Artery Bypass Graft (CABG) surgery (n=62). On-pump CABG vs. Off-pump CABG was evaluated on Intraoperative levels of plasma Kyn, IL-6, WBCs, and Trp/Kyn ratio. On-pump CABG was associated with more significant intraoperative increases in inflammatory markers (Kyn, IL-6, WBCs) and decreases in Trp/Kyn ratio compared to off-pump CABG.
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