Inflammatory response after coronary revascularization: off-pump versus on-pump (heparin-coated circuits and poly2methoxyethylacrylate-coated circuits).
OBJECTIVE
Off-pump coronary artery bypass grafting (OPCAB) may reduce the inflammatory response associated with cardiopulmonary bypass (CPB) and contribute to minimizing postoperative complications. Heparin-coated circuits and poly2methoxyethylacrylate (PMEA)-coated circuits were developed to reduce such complications. We compared the postoperative inflammatory response with or without CPB.


METHODS
Eighteen consecutive patients undergoing isolated coronary artery bypass grafting (CABG) were divided into three groups: OPCAB group (n=6), heparin-coated circuits group (n=6), PMEA-coated circuits group (n=6). The plasma concentrations of the following inflammatory markers were measured: cytokines [interleukin (IL-10)], polymorphonuclear elastase (PMNE), coagulofibrinolytic factor [thrombin-antithrombin III complex (TAT)], complement factor (C3a).


RESULTS
At the end of CPB, IL-10 and TAT concentrations were significantly different among the three groups (OPCAB group < PMEA-coated group < heparin-coated group). The PMNE concentration was significantly lower in the OPCAB group and the heparin-coated group as compared to the PMEA-coated group both at the end of CPB and 4 hours after CPB. C3a concentration was significantly lower in the OPCAB group than in the CPB groups at the end of CPB. Clinical variables did not differ significantly among the three groups.


CONCLUSIONS
Off-pump CABG is associated with a reduction in the inflammatory response when compared with on-pump CABG, using either PMEA-coated or heparin-coated circuits.
Hazama
Shiro
S
Department of Cardiovascular Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Eishi
Kiyoyuki
K
Yamachika
Shiro
S
Noguchi
Manabu
M
Ariyoshi
Tsuneo
T
Takai
Hideaki
H
Odate
Tomohiro
T
Matsukuma
Seiji
S
Onohara
Daisuke
D
Yanatori
Makoto
M
D000179:Acrylates / Q000494:pharmacology; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000494:pharmacology; D001672:Biocompatible Materials / Q000494:pharmacology; D015415:Biomarkers; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D007107:Immune System / Q000187:drug effects; D007249:Inflammation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000494:pharmacology; D016896:Treatment Outcome
D000179:Acrylates; D000925:Anticoagulants; D001672:Biocompatible Materials; D015415:Biomarkers; D011108:Polymers; C413485:poly(2-methoxyethylacrylate); D006493:Heparin