Paraoxonase Arylestarase and Oxıdatıve Stress in Coronary Artery Surgery Technıques with Desflurane Anesthesıa

Abstract

Background: Cardiovascular disease is the leading cause of morbidity in older people. Coronary artery bypass graft surgery is the most common type of operation performed in the world. Oxidative stress occurs in patients undergoing coronary artery bypass operation. The aim of this study was to investigate the difference in oxidative stress in off-pump versus on-pump coronary artery bypass surgery. We investigated patients undergoing traditional (on-pump) bypass surgery and bypass surgery performed on a beating heart (off-pump) who had been given antioxidant enzymes for high-density lipoprotein, as well as measured the levels of paraoxonase-1 (PON1), arylestarase (ARE), total antioxidant capacity (TAS), total oxidative stress (TOS), and oxidative stress index (OSI). Methods: A total of 40 patients (29 males, 11 females) underwent traditional on-pump bypass, and 30 (24 males, 6 females) underwent off-pump bypass. PON1, ARE, TAS, and TOS levels were measured, and OSI was calculated. Results: Preoperative and postoperative parameters were compared in the on-pump group, and only high OSI levels (P = .02) were found. No significant difference in operative parameters was found in the off-pump group. The serum values of OSI and TOS, were significantly greater in the on-pump group (P = .007, P = .008). Serum total cholesterol, HDL, low-density lipoprotein (LDL), triglyceride, and OSI levels were significantly higher preoperatively (after anesthesia induction) compared with the levels postoperatively (P < .001, P = .04, P = .007, P < .001, and P = .02, respectively) in the on-pump group, whereas the difference in the PON1, ARE, TAS, and TOS levels were not statistically significant.  No significant difference was found in the other parameters. Conclusions: On-pump bypass has long been considered the “gold standard” of treatment. However, our study has revealed that the newly developed beating heart off-pump bypass method results in less exposure of the patient to circulatory oxidative stress. Further studies are needed in order to confirm this hypothesis.