Comparative Analysis of Metabolomic Responses in On-Pump and Off-Pump Coronary Artery Bypass Grafting

Overview

Journal Ann Thorac Cardiovasc Surg

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2024 Dec 4

PMID 39631940

Authors

Chananya Karunasumetta

Wijittra Tourthong

Rachata Mala

Chotika Chatgasem

Theerayut Bubpamala

Suriya Punchai

Kittisak Sawanyawisuth

Affiliations

Soon will be listed here.

Abstract

Purpose: Although the clinical outcomes of on-pump (ONCAB) and off-pump CABG (OPCAB) are well established, their metabolomic impacts remain underexplored. This study aims to compare the metabolic profiles of ONCAB and OPCAB to identify differential metabolites associated with clinical outcomes.

Methods: In a prospective cohort study conducted between January 2023 and September 2023, 100 plasma samples from 20 patients undergoing isolated elective CABG (10 per group) were analyzed. Samples were collected preoperatively and at multiple postoperative time points (Days 0-3) and processed using proton nuclear magnetic resonance (H-NMR). Advanced statistical modeling was applied to identify differential metabolites.

Results: No significant differences were found in clinical outcomes, although ONCAB showed higher postoperative CKMB levels. Both procedures induced metabolomic alterations, with ONCAB demonstrating a more substantial impact, particularly on Day 0. Key metabolites, including leucine, succinate, creatine, glucose, and adenine, affected starch and sucrose metabolism.

Conclusion: ONCAB induces more pronounced metabolic shifts immediately postsurgery, involving protein and energy turnover, oxidative stress, and disrupted glucose metabolism, indicative of cellular stress responses. A comprehensive understanding of these metabolic changes is critical for informing targeted interventions and supports the use of OPCAB as a preferred strategy for patients with elevated metabolic risks.

References

Chowdhury R, White D, Kilgo P, Puskas J, Thourani V, Chen E . Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery. Ann Thorac Surg. 2012; 93(6):1936-41. DOI: 10.1016/j.athoracsur.2012.02.051. View

Zhou Z, Liang M, Zhuang X, Liu M, Fu G, Liu Q . Long-term Outcomes After On-Pump vs Off-Pump Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy. Ann Thorac Surg. 2022; 115(6):1421-1428. DOI: 10.1016/j.athoracsur.2021.12.063. View

Tadokoro N, Fukushima S, Minami K, Shimahara Y, Kawamoto N, Kakuta T . 15-year outcomes of the JOCRI study (JOCRIED study): a randomised comparison of off-pump and on-pump multiple arterial coronary revascularisation. Gen Thorac Cardiovasc Surg. 2022; 71(3):151-157. DOI: 10.1007/s11748-022-01854-y. View

Renguet E, Ginion A, Gelinas R, Bultot L, Auquier J, Frayne I . Metabolism and acetylation contribute to leucine-mediated inhibition of cardiac glucose uptake. Am J Physiol Heart Circ Physiol. 2017; 313(2):H432-H445. DOI: 10.1152/ajpheart.00738.2016. View

Galindo R, Fayfman M, Umpierrez G . Perioperative Management of Hyperglycemia and Diabetes in Cardiac Surgery Patients. Endocrinol Metab Clin North Am. 2018; 47(1):203-222. PMC: 5805476. DOI: 10.1016/j.ecl.2017.10.005. View

Kim J, Lee J, Kim S, Yoon D, Kim J, Sung D . Role of creatine supplementation in exercise-induced muscle damage: A mini review. J Exerc Rehabil. 2015; 11(5):244-50. PMC: 4625651. DOI: 10.12965/jer.150237. View

Caron A, Richard D, Laplante M . The Roles of mTOR Complexes in Lipid Metabolism. Annu Rev Nutr. 2015; 35:321-48. DOI: 10.1146/annurev-nutr-071714-034355. View

Combaret L, Dardevet D, Rieu I, Pouch M, Bechet D, Taillandier D . A leucine-supplemented diet restores the defective postprandial inhibition of proteasome-dependent proteolysis in aged rat skeletal muscle. J Physiol. 2005; 569(Pt 2):489-99. PMC: 1464228. DOI: 10.1113/jphysiol.2005.098004. View

Lynch C, Adams S . Branched-chain amino acids in metabolic signalling and insulin resistance. Nat Rev Endocrinol. 2014; 10(12):723-36. PMC: 4424797. DOI: 10.1038/nrendo.2014.171. View

10.

Correia G, Ng K, Wijeyesekera A, Gala-Peralta S, Williams R, MacCarthy-Morrogh S . Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease. Crit Care Med. 2015; 43(7):1467-76. PMC: 4467581. DOI: 10.1097/CCM.0000000000000982. View

11.

Balestrino M . Role of Creatine in the Heart: Health and Disease. Nutrients. 2021; 13(4). PMC: 8067763. DOI: 10.3390/nu13041215. View

12.

Turer A, Stevens R, Bain J, Muehlbauer M, van der Westhuizen J, Mathew J . Metabolomic profiling reveals distinct patterns of myocardial substrate use in humans with coronary artery disease or left ventricular dysfunction during surgical ischemia/reperfusion. Circulation. 2009; 119(13):1736-46. PMC: 2756963. DOI: 10.1161/CIRCULATIONAHA.108.816116. View

13.

Valls-Lacalle L, Barba I, Miro-Casas E, Ruiz-Meana M, Rodriguez-Sinovas A, Garcia-Dorado D . Selective Inhibition of Succinate Dehydrogenase in Reperfused Myocardium with Intracoronary Malonate Reduces Infarct Size. Sci Rep. 2018; 8(1):2442. PMC: 5799359. DOI: 10.1038/s41598-018-20866-4. View

14.

Chouchani E, Pell V, Gaude E, Aksentijevic D, Sundier S, Robb E . Ischaemic accumulation of succinate controls reperfusion injury through mitochondrial ROS. Nature. 2014; 515(7527):431-435. PMC: 4255242. DOI: 10.1038/nature13909. View

15.

McGarrah R, Zhang G, Christopher B, Deleye Y, Walejko J, Page S . Dietary branched-chain amino acid restriction alters fuel selection and reduces triglyceride stores in hearts of Zucker fatty rats. Am J Physiol Endocrinol Metab. 2019; 318(2):E216-E223. PMC: 7052576. DOI: 10.1152/ajpendo.00334.2019. View

16.

Bujak R, Struck-Lewicka W, J Markuszewski M, Kaliszan R . Metabolomics for laboratory diagnostics. J Pharm Biomed Anal. 2015; 113:108-20. DOI: 10.1016/j.jpba.2014.12.017. View

17.

Sun L, Lu J, Yu X, Li D, Xu X, Wang B . Adenine sulfate improves cardiac function and the cardiac cholinergic system after myocardial infarction in rats. J Pharmacol Sci. 2011; 115(2):205-13. DOI: 10.1254/jphs.10231fp. View

18.

Rapp-Kesek D, Stridsberg M, Andersson L, Berne C, Karlsson T . Insulin resistance after cardiopulmonary bypass in the elderly patient. Scand Cardiovasc J. 2007; 41(2):102-8. DOI: 10.1080/14017430601050355. View

19.

Shroyer A, Hattler B, Wagner T, Collins J, Baltz J, Quin J . Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. N Engl J Med. 2017; 377(7):623-632. DOI: 10.1056/NEJMoa1614341. View

20.

Davidson S, Ferdinandy P, Andreadou I, Botker H, Heusch G, Ibanez B . Multitarget Strategies to Reduce Myocardial Ischemia/Reperfusion Injury: JACC Review Topic of the Week. J Am Coll Cardiol. 2019; 73(1):89-99. DOI: 10.1016/j.jacc.2018.09.086. View