title: Endotoxemia in coronary artery bypass surgery: a comparison of the off-pump technique and conventional cardiopulmonary bypass.
abstract: OBJECTIVE
  The endotoxemia associated with cardiac surgery is thought to be dominantly influenced by the use of cardiopulmonary bypass. The objectives of this study were to assess the relative contribution of cardiopulmonary bypass on endotoxemia apart from cardiac surgical access and to improve our understanding of the potential benefits of off-pump procedures.
  
  
  METHODS
  Thirty patients undergoing coronary artery bypass grafting were followed up prospectively. The patients were divided into 2 equal groups: those who underwent bypass grafting through a sternotomy incision without cardiopulmonary bypass (off-pump group) and those who underwent bypass grafting through a sternotomy incision with cardiopulmonary bypass (CPB group). Blood sampling for endotoxin, lactate, and cardiac index measurements were performed during the following time points: (1) after sternotomy; (2) during the coronary occlusion period in the off-pump group and during aortic clamping in the CPB group; (3) after removal of the coronary occlusion sutures in the off-pump group and after removal of the aortic clamp in the CPB group; (4) 30 minutes after the completion of all distal anastomoses in the off-pump group and immediately after weaning from cardiopulmonary bypass in the CPB group; (5) 1 hour postoperatively; and (6) 12 hours postoperatively.
  
  
  RESULTS
  Endotoxin and lactate levels were significantly (P <.05) lower in the off-pump group at all sampling time points, except after sternotomy.
  
  
  CONCLUSIONS
  In conclusion, this study has shown that endotoxemia during coronary artery bypass surgery seems mainly to be associated with cardiopulmonary bypass procedure. The relatively lower endotoxin levels observed in off-pump surgery might contribute to improved postoperative recovery.
authors.affiliation: Division of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Marmara, Istanbul, Turkey. bigeaydin@ixir.com
authors.forename: Naz Bige
authors.initials: NB
authors.lastname: Aydin
authors.forename: Hakan
authors.initials: H
authors.lastname: Gercekoglu
authors.forename: Burak
authors.initials: B
authors.lastname: Aksu
authors.forename: Vedat
authors.initials: V
authors.lastname: Ozkul
authors.forename: Tufan
authors.initials: T
authors.lastname: Sener
authors.forename: Ilknur
authors.initials: I
authors.lastname: Kiygil
authors.forename: Tansel
authors.initials: T
authors.lastname: Turkoglu
authors.forename: Serdar
authors.initials: S
authors.lastname: Cimen
authors.forename: Funda
authors.initials: F
authors.lastname: Babacan
authors.forename: Murat
authors.initials: M
authors.lastname: Demirtas
mesh_terms: D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D019446:Endotoxemia / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies