Does cardiopulmonary bypass alter plasma level of tumor markers? CA 125 and carcinoembryonic antigen

BACKGROUND

In addition to malignant diseases, acute and chronic inflammations may elevate plasma levels of tumor markers CA 125 and carcinoembryonic antigen (CEA). Cardiopulmonary bypass (CPB) causes a generalized inflammatory response. In this study, we have investigated the effect of CPB on plasma levels of CA 125 and CEA.

METHODS

We measured plasma levels of CA 125 and CEA in patients undergoing coronary artery bypass grafting (CABG) with CPB (Group 1, n = 21), and in patients who underwent off-pump CABG, that is, without CPB (Group 2, n = 16). Blood samples were collected preoperatively, and on postoperative days 1, 6, and 12.

RESULTS

Within both groups, CEA plasma levels were not significantly influenced in any samples. Comparing with preoperative values, CA 125 values elevated significantly on postoperative days 6 and 12 within both groups. It was observed that the elevation of CA 125 plasma levels in these samples were significantly higher in Group 1.

CONCLUSIONS

The results indicate that CPB elevated plasma level of CA 125. However, clinical importance of this finding needed further evaluation.

Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 cases

OBJECTIVE

A total of 2052 patients operated on with the off-pump technique (coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation) between June 1993 and March 1996 are retrospectively reviewed. Predictors for early mortality, perioperative myocardial infarction, and low cardiac output state were statistically analyzed.

METHOD

Our indications for an off-pump procedure were either patients with technically suitable coronary lesions (the vast majority) or patients who could not tolerate cannulation, hypothermia, or cardiopulmonary bypass because of the poor left ventricular function (198 patients) and/or associated diseases or conditions (73 patients).

RESULTS

Overall operative mortality was 1.9% and perioperative myocardial infarction occurred in 59 patients (2.9%). According to logistic regression analysis, associated bronchial asthma (p = 0.0001), hypertension (p = 0.05), poor quality of the left anterior descending artery (p = 0.02), and ungrafted circumflex coronary artery disease (p = 0.007) were the early mortality predictors. Nonbypassed circumflex disease was also associated with a high incidence of perioperative myocardial infarction and low cardiac output state. No homologous blood or packed red cell transfusion was required in 74.2% of the patients.

CONCLUSION

On the basis of the presented data, off-pump coronary artery bypass grafting appeared to be a safe and effective technique in selected patients with appropriate coronary lesions.