title: Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial function: a prospective randomized study.
abstract: OBJECTIVE
  Cardiac surgery initiates a systemic inflammatory response, which may affect endothelial function. The aim of this study was to investigate if off-pump CABG (OPCAB) reduces the postoperative inflammatory response and affects endothelial function less than conventional on-pump CABG.
  
  
  METHODS
  Fifty-two patients submitted for elective CABG were included in a prospective, randomized study. Twenty-six patients were operated with, and 26 without cardiopulmonary bypass (CPB). Plasma levels of complement (C3a), cytokines (IL-8, TNF-alpha), endothelin-1 and neopterin were measured before and during surgery and 2 and 24 h after surgery. Endothelial function was assessed by forearm plethysmography and acetylcholine infusion in 30 patients 2-4 h after surgery.
  
  
  RESULTS
  C3a and neopterin concentrations were significantly higher during and early after surgery in the CPB group while TNF-alpha and IL-8 tended to be higher in the CPB group but the difference did not reach statistical significance. Endothelial function did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  OPCAB reduces complement activation compared with on-pump CABG but does not significantly affect TNF-alpha and IL-8 release or endothelial function.
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Johansson-Synnergren
authors.forename: Folke
authors.initials: F
authors.lastname: Nilsson
authors.forename: Anders
authors.initials: A
authors.lastname: Bengtsson
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.forename: Lars
authors.initials: L
authors.lastname: Wiklund
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D003167:Complement Activation / Q000187:drug effects / Q000502:physiology*; D015926:Complement C3a / Q000187:drug effects / Q000378:metabolism; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D019332:Endothelin-1 / Q000097:blood / Q000187:drug effects; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D009599:Nitroprusside / Q000008:administration & dosage; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000187:drug effects / Q000378:metabolism; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D019332:Endothelin-1; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D014665:Vasodilator Agents; D009599:Nitroprusside; D019798:Neopterin; D015926:Complement C3a; D000109:Acetylcholine