Comparative Analysis of Liver Function Test Alterations in Off-Pump Versus On-Pump Coronary Artery Bypass Surgery
Article Sidebar
Main Article Content
Abstract
Background: Coronary artery bypass grafting (CABG) may be accompanied by early changes in liver biochemistry. Objective: To compare perioperative liver biochemical alterations between on-pump and off-pump CABG. Methods: This prospective comparative observational study recruited 82 patients through convenience sampling at three tertiary cardiac centres in Lahore, Pakistan, with 41 patients per surgical group. Serum aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, albumin, and total and direct bilirubin were assessed preoperatively and at 24 and 48 hours postoperatively. Reported summary statistics were reanalysed using Welch’s t-tests, with on-pump minus off-pump mean differences, 95% confidence intervals (CIs), and Holm correction across 12 postoperative comparisons. Results: The on-pump group had higher postoperative enzyme activities and bilirubin and lower albumin at both assessments (all adjusted p < 0.001). At 24 hours, mean AST was 100.10 versus 48.48 U/L (difference 51.62 U/L; 95% CI 46.54–56.70). At 48 hours, mean albumin was 2.53 versus 3.56 g/dL (difference −1.030 g/dL; 95% CI −1.107 to −0.953). Enzyme activities declined between postoperative assessments, whereas bilirubin continued to increase. Conclusion: On-pump CABG was associated with greater early biochemical alterations than off-pump CABG; clinical significance and causality remain uncertain
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Abdulrahman RI, Parvizi R. Outcome of coronary artery bypass grafts: comparison between on pump and off pump. Acta Med Iran. 2010;48(3):158–63.
2. Zhang P, Wang L, Zhai K, Huang J, Wang W, Ma Q, et al. Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis. Perfusion. 2021;36(7):724–36.
3. Zakeri S, Vafaey H, Banihashem N, Alijanpour A, Gholinia H, Behzad C. Evaluation of liver function tests after coronary artery bypass surgery (CABG). Caspian J Intern Med. 2021;12(1):45–52.
4. Shang L, Ao Y, Lv L, Zhang Y, Hou J, Yao J, et al. Preoperative liver function test abnormalities were associated with short-term and long-term prognosis in cardiac surgery patients without liver disease. Front Cardiovasc Med. 2021;8:772430.
5. Iqbal UJ, Hanif MI, Iqbal N. Effect of cardiopulmonary bypass on liver function in patients undergoing coronary artery bypass grafting. Biomedica. 2015;31(1):27–31.
6. Alkhowaiter AY, Alshuweishi FA. Evaluation of factors affecting liver function test in patients underwent coronary artery bypass graft surgery. 2020;2(5):1–7.
7. Sabzi F, Faraji R. Liver function tests following open cardiac surgery. J Cardiovasc Thorac Res. 2015;7(2):49–54.
8. Valentine EH. Liver function tests. Penn Med J. 1947;50(6):602–5.
9. Yamada T, Ochiai R, Takeda J, Kikuchi H, Ishibashi M, Watanabe K. Off-pump coronary artery bypass attenuates transient hepatocellular damage after myocardial revascularization. J Cardiothorac Vasc Anesth. 2005;19(5):603–7.
10. Bayram H, Zor MH, Erer D, Iriz E, Ozdogan ME, Oktar L. On-pump cardiopulmonary bypass versus off-pump coronary artery bypass grafting surgery: renal and liver function tests. Gazi Med J. 2016;27(1):1–4.
11. Aykut A, Zengin EN, Demir ZA. Acute hepatic injury following cardiac surgery: retrospective observational study. Anestezi Derg. 2023;31(4):283–90.
12. Abdo A, Gamil E, Farrag M, Housieny M. Short-term outcome of off pump versus on pump coronary artery bypass grafting. Al-Azhar Int Med J. 2022;3(4):Epub ahead of print.