| Off-pump coronary artery bypass grafting surgery (OPCAB) is widely applied in the surgical treatment of coronary heart disease. However, postoperative vascular patency of the graft (especially the vein) has been a major area of concern. Some literature reported the vein graft clogging rate is about15～20%in the first year. Vascular stenosis is one of the main adverse outcomes after OPCAB. Early postoperative bridge clogged is related with arterial and venous thrombus formation in patients who have riecived coronary artery bypass grafts. Thrombosis is associated with changes of perioperative coagulation and inflammation status. The present research will explain it from the following three aspects.1. Gene Polymorphism and Inflammation after Coronary Artery Bypass Grafting SurgeryBackground Inflammation plays a key role in coronary artery disease. Coronary artery bypass grafting surgery (CABG) is associated with a systemic inflammatory response syndrome and compensatory anti-inflammatory response syndrome that are known to affect the outcome after cardiac surgery. The present study was designed to define whether the balance of IL-6, IL-8, IL-10and TNF-a release in response to cardiac surgery is related to the presence of a certain allele in the functional polymorphism and its relationship to clinical outcome.Method. One hundred and fifty patients underwent first time elective OPCAB were collected. They were genotyped for IL-6(-174G>C), IL-8(-251A>T) IL-10(-1082G>A) and TNF-α (-308G>A) polymorphisms using PCR and gene sequencing. Cytokine levels were measured on plasma samples taken before the operation and4,24and72hours postoperatively by suspension array system.Results IL-6, IL-8, IL-10concentrations increased after surgery. However, TNF-a concentrations decreased (P<0.05). Patients homozygous for IL-6-174G had higher circulating levels of IL-6(P<0.05). IL-8-251AA genotype had higher concentration of IL-8(P<0.05). In IL-10-1082AA group, levels of IL-10were increased (P<0.05). Levels of TNF-a in AG and GG genotype groups were not different. In this study, IL-8-251AA was an independent risk factor of ventilation more than1day (OR=11.80,95%CI:1.87～74.48) and hospital stay after surgery more than14days (OR=38.00,95%CI:4.15～347.87). Higher production of IL-8and IL-10was associated with longer ventilation time and longer hospital stay after surgery (P<0.05).Conclusions Off-pump CABG results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic background might alter the extent of inflammatory response and relate to postoperative prognosis.2. Coagulative Disfunction after Coronary Artery Bypass GraftinsBackground Postoperative vascular patency of the graft (especially the vein graft) has been a major area of concern of OPCAB. The present study was designed to analysis the changes of coagulation function after OPCAB by detecting FVII, vWF, PAI-1and D-dimer.Methods150patients received first time OPCAB were recruited. Antiplatelet therapy was ceased3-7days before surgery. Aspirin was taken6hours after the operation. Low molecular weight heparin (LMWH) was given the first day after operation. FVII, PAI-1, vWF, and D-dimer were detected preoperatively and on postoperative1,4,7,14days,1,2,3months. Clinical data was also recorded at the same time. Logistic regression was performed to analyze the risk factors of coagulation dysfunction.Results FⅦ reduced on the1st day and recovered to the normal level [91[88,98]%] on the postoperative14th day. vWF and PAI-1increased significantly on the4th day after operation (P<0.05). They decreased to baseline on the14th postoperative day. The level of D-dimer increased after OPCAB. Until1month after surgery, it reached the top (1940[1067,2703] μg/L).3months after operation, D-dimer went back to baseline (370[180,560]μg/L). One year follow-up results indicated that25patients suffered angina pectoris again. Logistic regression showed Tissue Factor-1208Ⅱ genotype was an independent factor of it (OR=8.864,95%CI:1.613～46.743).Conclusion A certain degree of hypercoagulable and hyperfibrinolytic state exists after OPCAB. Anticoagulation and antiplatelet therapy may have some effect for surgical outcomes and long-term graft patency. 3. Aspirin Resistance After Off-pump Coronary Artery Bypass Grafting SureervBackground:Aspirin is an important drug proven to reduce saphenous vein graft failure, but aspirin resistance frequently occurs after OPCAB. The present study was designed to describe the incidence of aspirin resistance, and evaluate the aspirin effectiveness in the inhibition of platelet aggregation and thromboxane formation in patients after OPCAB.Methods:300patients were recruited.150patients underwent first time OPCAB (Surgery Group). Arachidonic acid induced platelet aggregation and urine11-dehydro thromboxane B2(11-dehydroTxB2) were measured before operation and on aspirin re-administered days1,4,10, and6months after surgery. The same tests were also detected in150patients from the Cardiology Department (Non-surgery Group) received medicine therapy as controls. The sequence was drawn to analyze the association between aspirin resistance and genetic polymorphisms of GP1Bα (C1018T), PI (A1/A2), P2Y1(A1622G) and TBXA2R (T924C).Results:102patients were defined as aspirin sensitive after OPCAB (AS Group). Postoperative aspirin resistance was identified in48(32%) patients at the first day after aspirin treatment started (AR Group).19(13.3%) and5(3.3%) patients remained as AR at day4and10after aspirin re-administration, respectively. Patients in the AR group had higher11-dehydroTxB2levels than those in the AS group (P<0.05). Six months follow-up showed no resistance was found. All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and11-dehydroTxB2were similar as those in the AS Group. Logistic regression showed BMI>27kg/m2(OR=2.732,95%CI:1.074-6.954) and TBXA2R (924TT) genotype (OR=4.479,95%CI:1.811-11.077) are independent factors of AR after OPCAB.Conclusions:Aspirin resistance is encountered during the early postoperative period in a certain patients undergoing OPCAB. In case of resistance, treatment would need to be tailored to the individual. BMI>27kg/m2and TBXA2R (924TT) are independent factors of AR after OPCAB. |
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