Off-Pump and On-Pump Techniques and Oxidative Stress in CABG Surgery

Study Overview
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Brief Summary
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CABG (coronary artery bypass graft) surgery is among the most common heart surgeries performed in the heart pump. In CABG surgery, operations performed on the beating heart without the use of CPB (off-pump) are frequently performed (30-60%) (1). To the best of our knowledge, there has been no study examining cerebral oxygenation values, oxidative stress levels and postoperative results in CABG operations.

Detailed Description
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CABG (coronary artery bypass graft) surgery is among the most common heart surgeries performed in the heart pump. In CABG surgery, operations performed on the beating heart without the use of CPB (off-pump) are frequently performed (30-60%) (1). Off-pump coronary artery bypass surgery is also called beating-heart surgery, and its purpose is to avoid cardiopulmonary bypass completely without the support of a heart lung machine, thereby avoiding its adverse effects (3-5). It has been reported that the off-pump CPB surgical method is associated with a decrease in the incidence of early stage and major complications compared to the traditional CPB method (2). Exposure to surgical stress leads to autonomic, visceral, and immunological responses, leading to oxidative stress, neurochemical and hormonal abnormalities (3).In addition to the non-physiological hemodynamic conditions that occur during CABG surgery, a significant increase is observed in inflammatory response and oxidative stress biomarkers due to surgical trauma, cardiopulmonary bypass (CPB) and organ reperfusion injury (4).For this reason, it is important to detect the presence and severity of postoperative adverse outcomes after CABG early. To the best of our knowledge, there has been no study examining cerebral oxygenation values, oxidative stress levels and postoperative results in CABG operations. This prospective observational study is planned to include 64 adult patients aged 30-80 years who will undergo CABG surgery. Patients will be grouped according to the surgical technique (on-pump and off-pump) determined (indicated) according to the cardiovascular risk status of the patient by the Cardiovascular Surgery department. Patients' perioperative cerebral hemoglobin oxygen saturations will be recorded with the Regional Oximeter (non-invasive cerebral oxygenation measurement device). In patients undergoing On-Pump bypass, at the beginning of the CABG surgery (basal), during the aortic clamp, 15 minutes after the clamp is lifted, the remaining 3 ml of blood will be centrifuged at 3000 rpm for 5 minutes and the serum part will be separated. In off-pump bypass surgery patients, 3 ml of blood will be centrifuged at the beginning of the operation, at the beating phase and 15 minutes after the beating process is completed. Total antioxidant status, Total oxidant status, Superoxide dismutase, Malondialdehyde will be measured in the Enzyme-Linked ImmunoSorbent Assay device from blood samples taken from all patients in the study, and their concentrations will be determined.

Official Title
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Effect of Off-Pump and On-Pump Techniques on Oxidative Stress Biomarkers in CABG

Conditions
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Cerebral Oxygenation, Oxidative Stress, Myocardial Infarction

Intervention / Treatment
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* Procedure: On-Pump CABG
* Procedure: Off-Pump CABG


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Undergo CABG surgery with on-pump and off-pump technique, Volunteer to participate in the study, 30-80 years old Exclusion Criteria: Those with chronic kidney failure Those with liver failure Under 30 and over 80

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| On-pump CABG<br>Patients with an on-pump indication by the cardiovascular surgery department will be included in the study. | Procedure: On-Pump CABG<br>* Patients who have undergone on-pump Coronary artery bypass grafting (CABG) surgery are planned by the Department of Cardiovascular Surgery.<br>Procedure: Off-Pump CABG<br>* Patients who have undergone off-pump Coronary artery bypass grafting (CABG) surgery are planned by the Department of Cardiovascular Surgery.<br>|
| Off-pump CABG<br>Patients with an off-pump indication by the cardiovascular surgery department will be included in the study. | Procedure: On-Pump CABG<br>* Patients who have undergone on-pump Coronary artery bypass grafting (CABG) surgery are planned by the Department of Cardiovascular Surgery.<br>Procedure: Off-Pump CABG<br>* Patients who have undergone off-pump Coronary artery bypass grafting (CABG) surgery are planned by the Department of Cardiovascular Surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oxidative stress level | Oxidative stress biomarker levels between on-pump and off-pump coronary artery bypass groups | Intraoperative period | 
| TAS | Total antioxidant status | Intraoperative period | 
| TOS | Total oxidant status | Intraoperative period | 
| SOD | Superoxide dismutase | Intraoperative period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral oximetry | Cerebral haemoglobin oxygen saturations (%) | Intraoperative period | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary artery bypass surgery, Oxidative stress, Cerebral oxygenation