Influences of off-pump coronary artery bypass grafting and coronary artery bypass grafting on organ damage and Th1/Th2 immune balance in elderly patients with coronary heart disease

JIN Wen-Jie; LI Xiu-yuan; HAO Rui

doi:10.3969/j.issn.1674-4055.2017.06.20

Abstract：Objective To investigate the influences of off-pump coronary artery bypass grafting (OPCABG) coronary artery bypass grafting (CABG) on organ damage and Th1/Th2 immune balance in elderly patients with coronary heart disease (CHD).Methods Elderly CHD patients (n=102 and average age=73.5±5.4) were chosen from the First People's Hospital of Yibin City from Nov. 2014 to Nov. 2016, and then randomly divided into OPCABG group and CABG group (eachn=51). The difference in sex and age had no statistical significance between 2 groups. The curative effects (including bypass flow volume, transfusion volume, number of bypass vessels, intubation duration and mechanical ventilation duration) and surgical complications (including incidence of respiratory failure, second chest-open surgery and new-onset atrial fibrillation, duration of hospital stays, mortality, and incidence of pulmonary infection, acute renal failure and cerebral infarction) were compared between 2 groups. The levels of biochemistry indexes of organ damage including creatine kinase-M B isoenzyme (CK-MB), cardiac troponin I (cTnI), aspertate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine (SCr) and blood urea nitrogen (BUN), and indexes of Th1/Th2 immune balance including interferon γ (IFN-γ), interleukin-4 (IL-4) and ratio of INF-γ to IL-4 (INF-γ/IL-4) were detected.Results The bypass flow volume, transfusion volume, number of bypass vessels, intubation duration and mechanical ventilation duration, and incidence of respiratory failure, second chest-open surgery and new-onset atrial fibrillation, duration of hospital stays, mortality, and incidence of pulmonary infection, acute renal failure and cerebral infarction were all significantly lower in OPCABG group than those in CABG group (allP<0.05). The levels of CK-MB, cTnI, AST, ALT, SCr and BUN were significantly lower (allP<0.05), and oxygenation index (OI) was significantly higher (P<0.05) in OPCABG group than those in CABG group after the surgery for 4 h, 8 h, 12 h, 24 h and 48 h. The difference in levels of INF-γ, IL-4 and INF-γ/IL-4 had no statistical significance between 2 groups at all time points (allP>0.05).Conclusion OPCABG and CABG both can induce organ damage and influence Th1/Th2 immune balance, while OPCABG has less damage and higher curative effect in elderly CHD patients.