Comparison of inflammatory responses after off-pump and on-pump coronary surgery using surface modifying additives circuit.
BACKGROUND
Cardiac surgery is followed by various degrees of inflammation, which have harmful consequences. Because of the central role of extracorporeal circulation (EC), off-pump coronary bypass surgery is deemed preferable. Do different modalities of EC challenge this view?


METHODS
Four groups of similar patients underwent coronary surgery: (group 1) on-pump, EC with closed surface modifying additives (SMA) circuit and no pump suckers (n = 20); (group 2) on-pump, EC with open SMA circuit and pump suckers (n = 20); (group 3) off-pump (beating heart) and heparin 3 mg/kg (n = 20); (group 4) off-pump (beating heart) and heparin 1 mg/kg (n = 20). Interleukins (IL)-6, IL-8, IL-10, myeloperoxidase, elastase, and terminal complex of the complement (TCC) were analyzed at various times: at induction (time I); after heparin (time II); after complete revascularization (time III); after protamine (time IV); and 24 hours later (time V).


RESULTS
The TCC was significantly higher in groups 1 and 2 at time III. The pattern of IL-6 was the same for the four groups. No significant difference in myeloperoxydase content was noted; however, elastase was significantly higher in the two EC (on-pump) groups.


CONCLUSIONS
Except for the complement system and elastase, on-pump surgery with SMA-coated circuits did not elicit any greater inflammatory response than off-pump surgery.
Quaniers
Janine M
JM
Department of Surgery, Biostatistics, University of Liège, Liège, Belgium.
Leruth
Julie
J
Albert
Adelin
A
Limet
Raymond R
RR
Defraigne
Jean-Olivier
JO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003167:Complement Activation / Q000502:physiology; D015938:Complement Membrane Attack Complex / Q000032:analysis; D001026:Coronary Artery Bypass / Q000009:adverse effects; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010196:Pancreatic Elastase / Q000097:blood; D009195:Peroxidase / Q000097:blood
D015938:Complement Membrane Attack Complex; D015850:Interleukin-6; D016209:Interleukin-8; D016753:Interleukin-10; D009195:Peroxidase; D010196:Pancreatic Elastase