title: Off-pump surgery does not eliminate microalbuminuria or other markers of systemic inflammatory response to coronary artery bypass surgery.
abstract: OBJECTIVE
  To evaluate whether off-pump surgery attenuates microalbuminuria and other markers of systemic inflammatory response to coronary artery bypass surgery as compared to surgery performed using cardiopulmonary bypass.
  
  
  METHODS
  Forty-three adult patients undergoing elective coronary artery bypass grafting surgery were operated on with or without cardiopulmonary bypass (CPB). Microalbuminuria, serum C-reactive protein, and oxygenation and lung function parameters were measured at several time points until the first postoperative morning.
  
  
  RESULTS
  The urinary albumin/creatinine ratio was low in both groups before surgery, but reached a maximum level at the end of CPB or just after opening the last coronary artery clamp in the off-pump group (p<0.05). The urinary albumin/creatinine ratio remained slightly elevated in both groups until the morning after the operation (p<0.05). There were no statistical differences between groups. Serum C-reactive protein remained at the initial level the evening after the operation, but increased by the first postoperative morning in both groups (p<0.001). The alveolar-arterial gradient for oxygen partial pressure rose significantly after the operation in the intensive care unit in both groups (p<0.0001). The shunt fraction of the pulmonary circulation did not change in either group.
  
  
  CONCLUSIONS
  Off-pump coronary artery surgery did not prevent the acute phase inflammatory response measured in the present study. The acute phase inflammatory response after coronary artery bypass surgery is more likely a response to the surgical trauma itself rather than to CPB.
authors.affiliation: Department of Clinical Chemistry, Savonlinna Central Hospital, Savonlinna, Finland.
authors.forename: Aimo
authors.initials: A
authors.lastname: Harmoinen
authors.forename: Liisa
authors.initials: L
authors.lastname: Kaukinen
authors.forename: Timo
authors.initials: T
authors.lastname: Porkkala
authors.forename: Matti
authors.initials: M
authors.lastname: Tarkka
authors.forename: Seppo
authors.initials: S
authors.lastname: Kaukinen
mesh_terms: D000419:Albuminuria / Q000175:diagnosis; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D002199:Capillary Permeability; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000652:urine; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000175:diagnosis*; D011652:Pulmonary Circulation
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine