Activation of complement and leukocyte receptors during on- and off pump coronary artery bypass surgery.
OBJECTIVE
The aim of this prospective, randomised study was to investigate the influence of extracorporeal circulation on the inflammatory response, our hypothesis being that off pump coronary artery bypass grafting (OFFCAB) procedures would generate less activation than on pump procedures (ONCAB).


METHODS
Patients admitted for elective CABG were randomised to either ONCAB or OFFCAB surgery and blood samples were taken during and up to 24 h after the operation. We measured complement factors C5a and the terminal complement complex (TCC, C59-b), and the interleukins IL-6 and IL-8. Leukocytes were studied for cellular counts and adhesion molecules (CD11b, CD35 and CD62L) by flow cytometry. We included a combination of activity markers with different aspects of neutrophil function and combined these with in vitro activation.


RESULTS
The complement factors C5a and TCC showed a more rapid (P=0.02, P<0.001) and TCC a more profound (P<0.001) increase in the ONCAB group than in the OFFCAB group during the operation, after that there were no inter-group differences. Cellular markers, cell counts and interleukin levels were activated by surgery but with no difference between groups.


CONCLUSIONS
This prospective, randomised study showed less complement activation in low risk OFFCAB, compared to ONCAB patients.
Wehlin
Lena
L
Department of Clinical Immunology, Institution of Medicine, Karolinska Institutet, Stockholm, Sweden. lena.wehlin@ks.se
Vedin
Jenny
J
Vaage
Jarle
J
Lundahl
Joachim
J
D000368:Aged; D003167:Complement Activation / Q000276:immunology*; D003182:Complement C5 / Q000276:immunology; D001026:Coronary Artery Bypass / Q000379:methods*; D004804:Eosinophils / Q000502:physiology; D005112:Extracorporeal Circulation; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007249:Inflammation / Q000276:immunology*; D007378:Interleukins / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation / Q000276:immunology; D011446:Prospective Studies; D016028:Receptors, Leukocyte-Adhesion / Q000276:immunology*
D003182:Complement C5; D007378:Interleukins; D016028:Receptors, Leukocyte-Adhesion