Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Dynamics of myocardial injury and systemic inflammatory responselaboratory markers in coronary artery bypass surgerywith and without cardiopulmonary bypass in low-risk patients

Authors: L.S. Selimyan, D.Sh. Samuilova, V.Yu. Merzlyakov, I.V. Klyuchnikov, I.Yu. Sigaev

Company:
Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2017-14-1-21-30

UDC: 616.127-001-089.819.5:616.12-089.8-78

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (1): 21-30

Quote as: Selimyan L.S., Samuilova D.Sh., Merzlyakov V.Yu., Klyuchnikov I.V., Sigaev I.Yu. Dynamics of myocardial injury and systemic inflammatory response laboratory markers in coronary artery bypass surgery with and without cardiopulmonary bypass in low-risk patients. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (1): 21–30 (in Russ.).

Received / Accepted:  13.02.2017/27.02.2017

Full text:  

Abstract

Objective – to conduct a comparative assessment of myocardial injury (MI) and the extent of the systemic inflammatory response (SIR) in coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and on a beating heart (OPCAB) in low-risk patients.
Material and methods. The study included 55 patients with ischemic heart disease. Depending on the nature of the surgery, the patients were divided into two groups. CABG on the beating heart was performed in patients in Group 1 (n = 29), the 2nd group included 26 patients who underwent CABG with CPB. All patients underwent a median sternotomy. Prior to surgery and in the dynamics of post-operative period for monitoring the perioperative myocardial injury were studied cardiac troponin I (cTnI), MB fraction of creatine kinase (CK-MB), pregnancy-associated plasma protein A (PAPP-A) levels, to evaluate the postoperative systemic inflammatory response – the values of serum interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP), lipopolysaccharide binding protein (LBP).
Results. On the 1st post-operative day (POD) the cTnI levels were statistically different between the groups: 3 (1: 5) and 6 (2; 15) ng/ml in the 1st and 2nd groups, respectively (p < 0.05). Later on the POD 3 and 7 the cTnI levels were gradually decreased and were statistically comparable in both groups (p > 0,05). The values of CK-MB on the POD 1 were lower in the first group compared to the second group, but this difference was not statistically significant (p > 0,05). Analysis of PAPP-A values in the early postoperative period did not reveal any significant changes in relation to the preoperative values. The dynamics of the IL-6, hsCRP and LBP was comparable between two groups at all time points (p > 0,05).
Conclusion. In the early postoperative period CABP with CPB transient myocardial injury was observed. This was accompanied by a large increase in the level of cardiac troponin I in comparison with CABG on a beating heart. The trigger factor for the development of SIR in CABG with and without CPB is the surgical trauma. Influence of CPB and aortic cross-clamping of acute inflammation phase is less significant.

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