A Comparison of Inflammatory Responses Between Robotically Enhanced Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass Grafting

Implications for Hybrid Revascularization

Galina Leyvi, Kumar Vivek, Sankalp Sehgal, Adrienne Warrick, Kea Alexa Moncada, Nancy Shilian, Jonathan D. Leff, Robert E. Michler, Joseph DeRose

Research output: Contribution to journalArticle

Abstract

Objective: The inflammatory response elicited by robotically enhanced coronary artery bypass grafting (r-CABG) has not been well described. When r-CABG is performed as part of hybrid coronary revascularization, the inflammatory milieu and the timing of percutaneous coronary intervention may affect the stent patency negatively in the short and long term. The goal of this study was to describe the extent and time course of cytokine release after r-CABG compared with conventional CABG (c-CABG) and to elucidate the optimal timing for r-CABG in the setting of hybrid coronary revascularization for a future study. Design: Prospective, observational study. Setting: Tertiary-care center in a university hospital. Participants: The study comprised patients scheduled to undergo r-CABG or c-CABG from October 2012 to November 2014. Interventions: Cytokine levels of interleukin (IL)-6, IL-8, IL-10; tumor necrosis factor-α; and C-reactive protein (CRP) were measured at the following time points: preprocedure; at the end of the procedure; and at 4, 8, 12, 24, and 48 hours after the procedure. Measurements and Main Results: Twenty-eight patients undergoing r-CABG and 10 patients undergoing c-CABG were enrolled. The levels of cytokines after r-CABG and c-CABG were compared using the mixed-effect linear regression model for longitudinal data. Cytokine release in the r-CABG group was comparatively less for IL-6, IL-10, tumor necrosis factor, and CRP levels. They all trended toward the baseline by the 48th hour in both groups, except CRP levels, which reached their peak at 48 hours in both groups. Conclusions: The inflammatory response to r-CABG was blunted compared with that of c-CABG. The high CRP levels on the second postoperative day after r-CABG were a cause for concern in regard to percutaneous coronary intervention performed at that time period, but additional studies are necessary.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - 2017

Fingerprint

Coronary Artery Bypass
C-Reactive Protein
Cytokines
Percutaneous Coronary Intervention
Interleukin-10
Linear Models
Interleukin-6
Lymphotoxin-beta
Interleukin-8
Tertiary Care Centers
Stents
Observational Studies
Tumor Necrosis Factor-alpha
Prospective Studies

Keywords

  • Hybrid coronary revascularization
  • Inflammatory response
  • Percutaneous coronary intervention
  • Robotically enhanced coronary artery bypass grafting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

@article{a835f0d3253547829a86739d0eebc07c,
title = "A Comparison of Inflammatory Responses Between Robotically Enhanced Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass Grafting: Implications for Hybrid Revascularization",
abstract = "Objective: The inflammatory response elicited by robotically enhanced coronary artery bypass grafting (r-CABG) has not been well described. When r-CABG is performed as part of hybrid coronary revascularization, the inflammatory milieu and the timing of percutaneous coronary intervention may affect the stent patency negatively in the short and long term. The goal of this study was to describe the extent and time course of cytokine release after r-CABG compared with conventional CABG (c-CABG) and to elucidate the optimal timing for r-CABG in the setting of hybrid coronary revascularization for a future study. Design: Prospective, observational study. Setting: Tertiary-care center in a university hospital. Participants: The study comprised patients scheduled to undergo r-CABG or c-CABG from October 2012 to November 2014. Interventions: Cytokine levels of interleukin (IL)-6, IL-8, IL-10; tumor necrosis factor-α; and C-reactive protein (CRP) were measured at the following time points: preprocedure; at the end of the procedure; and at 4, 8, 12, 24, and 48 hours after the procedure. Measurements and Main Results: Twenty-eight patients undergoing r-CABG and 10 patients undergoing c-CABG were enrolled. The levels of cytokines after r-CABG and c-CABG were compared using the mixed-effect linear regression model for longitudinal data. Cytokine release in the r-CABG group was comparatively less for IL-6, IL-10, tumor necrosis factor, and CRP levels. They all trended toward the baseline by the 48th hour in both groups, except CRP levels, which reached their peak at 48 hours in both groups. Conclusions: The inflammatory response to r-CABG was blunted compared with that of c-CABG. The high CRP levels on the second postoperative day after r-CABG were a cause for concern in regard to percutaneous coronary intervention performed at that time period, but additional studies are necessary.",
keywords = "Hybrid coronary revascularization, Inflammatory response, Percutaneous coronary intervention, Robotically enhanced coronary artery bypass grafting",
author = "Galina Leyvi and Kumar Vivek and Sankalp Sehgal and Adrienne Warrick and Moncada, {Kea Alexa} and Nancy Shilian and Leff, {Jonathan D.} and Michler, {Robert E.} and Joseph DeRose",
year = "2017",
doi = "10.1053/j.jvca.2017.04.045",
language = "English (US)",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - A Comparison of Inflammatory Responses Between Robotically Enhanced Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass Grafting

T2 - Implications for Hybrid Revascularization

AU - Leyvi, Galina

AU - Vivek, Kumar

AU - Sehgal, Sankalp

AU - Warrick, Adrienne

AU - Moncada, Kea Alexa

AU - Shilian, Nancy

AU - Leff, Jonathan D.

AU - Michler, Robert E.

AU - DeRose, Joseph

PY - 2017

Y1 - 2017

N2 - Objective: The inflammatory response elicited by robotically enhanced coronary artery bypass grafting (r-CABG) has not been well described. When r-CABG is performed as part of hybrid coronary revascularization, the inflammatory milieu and the timing of percutaneous coronary intervention may affect the stent patency negatively in the short and long term. The goal of this study was to describe the extent and time course of cytokine release after r-CABG compared with conventional CABG (c-CABG) and to elucidate the optimal timing for r-CABG in the setting of hybrid coronary revascularization for a future study. Design: Prospective, observational study. Setting: Tertiary-care center in a university hospital. Participants: The study comprised patients scheduled to undergo r-CABG or c-CABG from October 2012 to November 2014. Interventions: Cytokine levels of interleukin (IL)-6, IL-8, IL-10; tumor necrosis factor-α; and C-reactive protein (CRP) were measured at the following time points: preprocedure; at the end of the procedure; and at 4, 8, 12, 24, and 48 hours after the procedure. Measurements and Main Results: Twenty-eight patients undergoing r-CABG and 10 patients undergoing c-CABG were enrolled. The levels of cytokines after r-CABG and c-CABG were compared using the mixed-effect linear regression model for longitudinal data. Cytokine release in the r-CABG group was comparatively less for IL-6, IL-10, tumor necrosis factor, and CRP levels. They all trended toward the baseline by the 48th hour in both groups, except CRP levels, which reached their peak at 48 hours in both groups. Conclusions: The inflammatory response to r-CABG was blunted compared with that of c-CABG. The high CRP levels on the second postoperative day after r-CABG were a cause for concern in regard to percutaneous coronary intervention performed at that time period, but additional studies are necessary.

AB - Objective: The inflammatory response elicited by robotically enhanced coronary artery bypass grafting (r-CABG) has not been well described. When r-CABG is performed as part of hybrid coronary revascularization, the inflammatory milieu and the timing of percutaneous coronary intervention may affect the stent patency negatively in the short and long term. The goal of this study was to describe the extent and time course of cytokine release after r-CABG compared with conventional CABG (c-CABG) and to elucidate the optimal timing for r-CABG in the setting of hybrid coronary revascularization for a future study. Design: Prospective, observational study. Setting: Tertiary-care center in a university hospital. Participants: The study comprised patients scheduled to undergo r-CABG or c-CABG from October 2012 to November 2014. Interventions: Cytokine levels of interleukin (IL)-6, IL-8, IL-10; tumor necrosis factor-α; and C-reactive protein (CRP) were measured at the following time points: preprocedure; at the end of the procedure; and at 4, 8, 12, 24, and 48 hours after the procedure. Measurements and Main Results: Twenty-eight patients undergoing r-CABG and 10 patients undergoing c-CABG were enrolled. The levels of cytokines after r-CABG and c-CABG were compared using the mixed-effect linear regression model for longitudinal data. Cytokine release in the r-CABG group was comparatively less for IL-6, IL-10, tumor necrosis factor, and CRP levels. They all trended toward the baseline by the 48th hour in both groups, except CRP levels, which reached their peak at 48 hours in both groups. Conclusions: The inflammatory response to r-CABG was blunted compared with that of c-CABG. The high CRP levels on the second postoperative day after r-CABG were a cause for concern in regard to percutaneous coronary intervention performed at that time period, but additional studies are necessary.

KW - Hybrid coronary revascularization

KW - Inflammatory response

KW - Percutaneous coronary intervention

KW - Robotically enhanced coronary artery bypass grafting

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U2 - 10.1053/j.jvca.2017.04.045

DO - 10.1053/j.jvca.2017.04.045

M3 - Article

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

ER -