title: Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress.
abstract: Cardiopulmonary bypass (CPB) has been recognized as a cause of complex systemic inflammatory response, which significantly contributes to several adverse postoperative complications. In the last few years, off-pump coronary artery bypass grafting has gained widespread diffusion as an alternative technique to conventional on-pump coronary artery bypass grafting. Surgeons supporting off-pump surgery state that the avoidance of the CPB and myocardial ischemia-reperfusion significantly reduces the postoperative systemic inflammatory response and other biological derangements and, possibly, may improve the clinical outcomes. We review, here, the available evidence concerning possible differences between off-pump and on-pump procedures in terms of inflammation, hemostasis and oxidative stress. Consistent differences in the involvement of these systems are observed, but they are limited to the final steps of the surgical procedures and the early hours after. These findings suggest that the global surgical trauma may be as important, or even more, as the CPB in terms of systemic inflammatory and coagulation-fibrinolytic pathway activation. Further studies are needed in order to confirm this hypothesis.
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, via Parea 4, 20138 Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.forename: Moreno
authors.initials: M
authors.lastname: Naliato
authors.forename: Massimo
authors.initials: M
authors.lastname: Porqueddu
authors.forename: Marco
authors.initials: M
authors.lastname: Zanobini
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D003167:Complement Activation; D003327:Coronary Disease / Q000276:immunology / Q000378:metabolism / Q000601:surgery*; D005342:Fibrinolysis; D006353:Heart-Assist Devices; D006487:Hemostasis; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007378:Interleukins / Q000097:blood; D007962:Leukocytes / Q000276:immunology; D018384:Oxidative Stress; D010196:Pancreatic Elastase / Q000097:blood; D010974:Platelet Aggregation; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D015415:Biomarkers; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D010196:Pancreatic Elastase