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Off-pump Coronary Artery Bypass Does Not Influence Biomarkers of Brain Injury, But Does Exacerbate the Systemic Inflammatory Response

Jeremiah R. Brown, Felix Hernandez, Peter A. Beaulieu, Robert A. Clough, Cynthia M. Whited, John D. Klemperer and Donald S. Likosky

Background: The protective effects of off-pump (OPCAB) compared to conventional (CCAB) coronary artery bypass graft surgery on neurological injury and inflammation has been controversial. We evaluated pre- and postoperative levels of the brain injury marker, S100β, and markers of inflammation, Interleukin-6 (IL-6) and high sensitivity C-reactive protein (hs-CRP) in a prospective randomized controlled trial.
Methods: A sub-group sample of the randomized controlled trial of 50 consecutive randomized patients (n=27 CCAB, n=23 OPCAB) was utilized for the present biomarker analysis. Each patient had blood drawn before and after surgery. Analysis of variance and Kruskal-Wallis were used to assess significant differences in biomarkers.
Results: There was no difference in post-procedure S100β (p=0.1) or change in S100β from baseline (p=0.9). Hs-CRP and IL-6 were higher in the OPCAB arm post-procedure (P_CRP=0.001; P_IL-6=0.053) and change from baseline (P_CRP=0.003; P_IL-6=0.001).
Conclusion: OPCAB did not result in preventing neurological injury over CCAB; however, OPCAB had significantly more inflammation than CCAB following the procedure.