Systemic inflammation present in patients undergoing CABG without extracorporeal circulation.
OBJECTIVE
This study was conducted to evaluate to what extent the cardiopulmonary bypass (CPB) procedure in patients undergoing coronary artery bypass grafting (CABG) contributes to the systemic inflammatory response. Therefore, we measured bactericidal permeability increasing protein (BPI) as an indicator of neutrophil activation, interleukin 6 as inducer of the acute phase response, and lipopolysaccharide binding protein and C-reactive protein as parameters of the acute phase response in patients undergoing CABG either with or without the use of CPB.


METHODS
Prospective study.


METHODS
Cardiopulmonary surgery department in a university hospital.


METHODS
Sixteen patients undergoing elective CABG were included. Eight patients underwent surgery with CPB, and eight patients underwent surgery without CPB (non-CPB).


METHODS
In the CPB group, blood samples were taken upon induction of anesthesia, at the start of aortic cross-clamping, at aortic unclamping, and 0.5, 4, 8, and 18 h thereafter. In the non-CPB group, blood samples were taken upon induction of anesthesia, and 0.5, 4, 8, and 18 h after completion of the bypass graft anastomoses.


RESULTS
BPI release from neutrophil granules markedly increased during surgery in CPB patients but not in non-CPB patients. The increase in acute phase reactants, however, was the same in both patient groups.


CONCLUSIONS
These data indicate that the acute phase response in CABG patients, which has historically been ascribed to the CPB procedure, is predominantly caused by the surgical procedure per se. Early neutrophil activation, however, is seen only when extracorporeal circulation is used.
Fransen
E
E
Department of Cardiopulmonary Surgery, University Hospital Maastricht, The Netherlands.
Maessen
J
J
Dentener
M
M
Senden
N
N
Geskes
G
G
Buurman
W
W
D000209:Acute-Phase Proteins / Q000032:analysis; D000210:Acute-Phase Reaction / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D023181:Antimicrobial Cationic Peptides; D001770:Blood Bactericidal Activity; D001798:Blood Proteins / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002352:Carrier Proteins / Q000097:blood; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D008875:Middle Aged; D018375:Neutrophil Activation; D011446:Prospective Studies; D013997:Time Factors; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D023181:Antimicrobial Cationic Peptides; D001798:Blood Proteins; D002097:C-Reactive Protein; D002352:Carrier Proteins; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D000099231:Lipopolysaccharide-Binding Protein; C021623:bactericidal permeability increasing protein