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4 . 2020

Comparison of three types of coronary artery bypass grafting: preliminary results of AMIRI-CABG trial

Abstract

Aim. To define type of coronary artery bypass grafting (CABG) associated with lower myocardial ischemic-reperfusion injury and lower inflammation response.

Material and method. We had performed non-randomized single center prospective clinical trial in First Saint-Petersburg Pavlov University and compared myocardial damage and inflammation response during off-, on-pump and pump-assisted CABG (Assessment of myocardial ischemic-reperfusion injury during off- and on-pump CABG (AMIRI-CABG) ClinicalTrials.gov Identifier: NCT03050489, 2016-2019 years. There were off-pump CABG group (n=177), on-pump CABG group (n=128) and pump-assisted CABG (n=33). Level of evidence II.

Results. TnI elevation after on-pump CABG was higher at the end of operation and just on the first day postoperatively than after off-pump CABG. But at the fourth day postoperatively TnI level in off-pump group was comparable with TnI level at the first day in on-pump group. TnI dynamic had decreasing pattern in on-pump group and increasing pattern in off-pump group. Inflammation response during 2 and 10 days postoperatively was lower in on-pump group. Prognostic value of TnI was acceptable [area under curve (AUC) = 0.8] for death during 30 days postoperatively period, and for MPO was moderate (AUC=0.7). Prognostic value of MPO for death demands further investigation.

Conclusion. On-pump CABG was associated with lower myocardial ischemic-reperfusion injury and lower inflammation response.

Keywords:coronary artery bypass grafting (CABG), off-pump coronary bypass grafting, on-pump coronary artery bypass grafting, ischemic-reperfusion injury, myeloperoxidase, circulatory-assisted on-pump CABG

Funding. Research grant of Pavlov State Medical University: "Evaluation of regeneration ability of patients who underwent CABG" (2018).
Conflict of interest. The authors declare no conflict of interest.
Contribution. Study design, data harvesting, database maintaining, statistical analysis, patients management, writing a manuscript - Bunenkov N.S.; writing an article, editing, patients management - Komok V.V.; molecular biological research Sokolov A.V.; editing of the article - Karpov A.A., Kostevitch V.A., Gorbunov N.P., Beliy S.A.; collection of data - Siddikov A.M.; treatment of patients - Lukashenko V.I., Kobak A.E.; research planning, editing of the article - Nemkov A.S., Khubulava G.G.
For citation: Bunenkov N.S., Komok V.V., Sokolov A.V., Karpov A.A., Siddikov A.M., Kostevitch V.A., Gorbunov N.P., Lukashenko V.I., Beliy S.A., Kobak A.E., Nemkov A.S., Khubulava G.G. Comparison of three types of coronary artery bypass grafting: preliminary results of AMIRI-CABG trial. Clinical and Experimental Surgery. Petrovsky Journal. 2020; 8 (4): 55-64. DOI: https://doi.org/10.33029/2308-1198-2020-8-4-55-64 (in Russian)

References 

1.    Khubulava G.G., Avaliani V.M. Myocardial protection during coronary artery bypass grafting: current state of the problem. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2013; 6 (5): 42-7. (in Russian)

2.    Sedov V.M., Nemkov A.S. Vasi I ii Ivanovich Kolesov: pioneer of coronary surgery. Eur J Cardiothorac Surg. 2014; 45 (2): 220-4.

3.    Averina T.B. Extracorporeal circulation. Annaly khirurgii [Annals of Surgery]. 2013; (2): 5-12. (in Russian)

4.    Gahl B., Gober V., Odutayo A., Tevaearai Stahel H.T., da Costa B.R., Jakob S.M., et al. Prognostic value of early postoperative troponin t in patients undergoing coronary artery bypass grafting. J Am Heart Assoc. 2018; 7 (5): e007743.

5.    Mol K., Hoeks S.E., Liem V.G.B., Stolker R.J., van Lier F. Postoperative troponin release is associated with major adverse cardiovascular events in the first year after noncardiac surgery. Int J Cardiol. 2019; 280: 8-13.

6.    Vermes E., Mesguich M., Houel R., Soustelle C., Le Besnerais P., Hillion M.L., et al. Cardiac troponin I release after open heart surgery: a marker of myocardial protection? Ann Thorac Surg. 2000; 70 (6): 2087-90.

7.    Mueller T., Egger M., Peer E., Dieplinger B. 5th generation cardiac troponin I and T assays in clinical routine - a head-to-head comparison with data from the Linz troponin (LITROP) study. Clin Chim Acta. 2018; 485: 195-204.

8.    Averina T.B., Samuilova D.S. Clinical benefits of using the phosphorylcholine coating of an extracorporeal circuit in babies weighing less than 5 kg. Anesteziologiya i reanimatologiya [Anesthesiology and Reanimatology]. 2010; (5): 28-33. (in Russian)

9. Parolari A., Poggio P., Myasoedova V., Songia P., Bonalumi G., Pilozzi A., et al. Biomarkers in coronary artery bypass surgery: ready for prime time and outcome prediction? Front Cardiovasc Med. 2015; 2: 39.

10.    Abrantes R.D., Hueb A.C., Hueb W., Jatene F.B. Behavior of ultrasensitive C-reactive protein in myocardial revascularization with and without cardiopulmonary bypass. Braz J Cardiovasc Surg. 2018; 33 (6): 535-41.

11.    Parolari A., Camera M., Alamanni F., Naliato M., Polvani G.L., Agrifoglio M., et al. Systemic inflammation after on-pump and off-pump coronary bypass surgery: a one-month follow-up. Ann Thorac Surg. 2007; 84 (3): 823-8.

12.    Sokolov A.V., Kostevich V.A., Gorbunov N.P., Grigor’eva D.V., Gorudko I.V., Vasil’ev V.B., et al. A link between active myeloperoxidase and chlorinated ceruloplasmin in blood plasma of patients with cardiovascular diseases. Meditsinskaya immunologiya [Medical Immunology]. 2018; 20 (5): 699-710. (in Russian)

13.    Panasenko O.M., Mihal’chik E.V., Gorudko I.V., Grigor’eva D.V., Sokolov A.V., Kostevich V.A., et al. The effects of antioxidants and hypohalous acid scavengers on neutrophil activation by hypochlorous acid-modified low-density lipoproteins. Biofizika [Biophysics]. 2016; 61 (3): 500-9. (in Russian)

14.    Gaudino M., Angelini G. D., Antoniades C., Bakaeen F., Benedetto U., Calafiore A.M., et al. Off-pump coronary artery bypass grafting: 30 years of debate. J Am Heart Assoc. 2018; 7 (16): e009934.

15.    Nardi P., Pellegrino A., Bassano C., Mani R., Chi-ariello G.A., Zeitani J., et al. The fate at mid-term followup of the on-pump vs. off-pump coronary artery bypass grafting surgery. J Cardiovasc Med (Hagerstown). 2015; 16 (2): 125-33.

16.    Thielmann M., Sharma V., Al-Attar N., Bulluck H., Bisleri G., Bunge J.J.H., et al. ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper. Perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J. 2017; 38 (31): 2392407.

17.    Huang W.H., Lee J.F., Wang D., Gou W.H., Chang C.Y., Wei J. Postischemia myocardial injury in coronary artery bypass patients (PP6). Transplant Proc. 2010; 42 (3): 725-8.

18.    Kolodziej A.R., Abo-Aly M., Elsawalhy E., Campbell C., Ziada K.M., Abdel-Latif A. Prognostic role of elevated myeloperoxidase in patients with acute coronary syndrome: a systemic review and meta-analysis. Mediators Inflamm. 2019; 2019: 2872607.

19.    De Lorenzo A., Pittella F., Rocha A. Increased preoperative C-reactive protein levels are associated with inhospital death after coronary artery bypass surgery. Inflammation. 2012; 35 (3): 1179-83.

20.    Jongman R.M., Zijlstra J.G., Kok W.F., van Har-ten A.E., Mariani M.A., Moser J., et al. Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic endothelial responses: a prospective randomized study. Shock. 2014; 42 (2): 121-8.

21.    Alam S.R., Stirrat C., Spath N., Zamvar V., Pessotto R., Dweck M.R., et al. Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. J Cardiothorac Surg. 2017; 12 (1): 115.

22. Markman P.L., Tantiongco J.P., Bennetts J.S., Baker R.A. High-sensitivity troponin release profile after cardiac surgery. Heart Lung Circ. 2017; 26 (8): 833-9.

23.    Beller J., Mehaffey J.H., Hawkins R.B., Lapar D.J., Kron I., Yarboro L., et al. Does Preoperative troponin level impact outcomes after coronary artery bypass grafting? J Am Coll Surg. 2017; 225 (4): S28-9.

24.    Bennett J.M., Reeves G., Billman G.E., Sturm-berg J.P. Inflammation, nature’s way to efficiently respond to all types of challenges: implications for understanding and managing «the epidemic» of chronic diseases. Front Med (Lausanne). 2018; 5: 316.

25. Grigor’eva D.V., Gorudko I.V., Kostevich V.A., Sokolov A.V., Buko I.V., Vasil’ev V.B., et al. Myeloperoxidase activity in blood plasma as a criterion of therapy for patients with cardiovascular disease. Biomeditsinskaya khimiya [Biomedical Chemistry]. 2016; 62 (3): 318-4. (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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