Produção Nacional
Revisado por pares
Reduced expression of systemic proinflammatory and myocardial biomarkers after off-pump versus on-pump coronary artery bypass surgery: A prospective randomized study
2009; Elsevier BV; Volume: 25; Issue: 2 Linguagem: Inglês
10.1016/j.jcrc.2009.06.009
ISSN1557-8615
AutoresCarlos Serrano, Juliana Almeida-de-Souza, Neuza Lopes, Juliano Lara Fernandes, José Carlos Nicolau, Maria Heloı́sa Souza Lima Blotta, José Antônio Franchini Ramires, Whady Hueb,
Tópico(s)Cardiac Ischemia and Reperfusion
ResumoThe effects of off-pump (OffPCABG) and on-pump (OnPCABG) coronary artery bypass grafting (CABG) on myocardium and inflammation are unclear. Compare the inflammatory response and myocardial injury from patients (pts) submitted to OffPCABG with those that undergo OnPCABG. Patients with normal left ventricular function were assigned to OffPCABG (n = 40) and OnPCABG (n = 41). Blood samples were collected before and 24 hours after surgery for determination of creatine kinase (CK)–MB (CK-MB), troponin I (cTnI), interleukin (IL)–6, IL-8, P-selectin, intercellular adhesion molecule (ICAM)-1 and C-reactive protein (CRP). Mortalities were registered at 12 months. Preoperative CK-MB and cTnI levels were 3.1 ± 0.6 IU and 1.2 ± 0.5 ng/mL for OffPCABG and 3.0 ± 0.5 IU and 1.0 ± 0.2 ng/mL for OnPCABG pts. Postoperative CK-MB and cTnI levels were 13.9 ± 6.5 IU and 19.0 ± 9.0 ng/mL for OffPCABG vs 29.5 ± 11.0 IU and 31.5 ± 10.1 ng/mL for OnPCABG (P < .01). OffPCABG and OnPCABG pts had similar preoperative IL-6 (10 ± 7 and 9 ± 13 pg/mL), IL-8 (19 ± 7 and 17 ± 7 pg/mL), soluble P-selectin (70 ± 21 and 76 ± 23 pg/mL), soluble ICAM–1 (117 ± 50 and 127 ± 52 ng/mL), and CRP (0.09 ± 0.05 and 0.11 ± 0.07 mg/L). At 24 hours, for OffPCABG and OnPCABG: IL-6 was 37 ± 38* and 42 ± 41*,† g/mL; IL-8, 33 ± 31* and 60 ± 15*,† pg/mL; soluble P-selectin, 99 ± 26 and 172 ± 30*,† pg/mL; soluble ICAM-1, 227 ± 47 and 236 ± 87*,† ng/mL; and CRP, 10 ± 11* and 14 ± 13*,† mg/L (*P < .01 vs preoperation; †P < .01 vs OffPCABG). Increased 24-hour postoperative CRP levels was the only marker to have significant positive correlations with events and occurred just for the OnPCABG pts. In-hospital and 1-year mortalities for the OnPCABG and OffPCABG pts were 2.0% and 2.2% (P = .1) and 2.7% and 4.7% (P = .06), respectively. Thus, the absence of CPB during CABG preserves better the myocardium and attenuates inflammation—however, without improving survival.
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