Off-pump cardiac surgery abolishes complement activation.
BACKGROUND
This prospective randomized study compared the inflammatory response in patients undergoing elective on-pump and off-pump coronary artery bypass grafting.


METHODS
Forty-four patients undergoing elective coronary artery bypass grafting were recruited with 22 patients randomized to on-pump heart surgery and 22 patients to off-pump coronary bypass surgery. Plasma levels of C3bc, the terminal SC5b-9 complement complex, myeloperoxidase, beta-thromboglobulin and prothrombin fragment F1 + 2 were measured before the operation, intraoperatively, at termination of the operation, and two hours post-operatively.


RESULTS
Complement was markedly activated in the on-pump group as indicated by a significant increase in C3bc and SC5b-9 (p < 0.001 for both), whereas no complement activation was seen in the off-pump group (p = 0.001 between the groups). In contrast, both groups showed significant activation of neutrophils, platelets and coagulation, as indicated by an early increase in myeloperoxidase and a post-operative increase in beta-thromboglobulin and F1 + 2, respectively. Notably, there were no intergroup differences with regard to neutrophil and platelet activation, whereas coagulation activation was more pronounced in the off-pump group (p < 0.01).


CONCLUSIONS
Off-pump surgery completely eliminated the heart-lung machine-induced complement activation. Neutrophils and platelets were equally activated in both groups, whereas coagulation was enhanced post-operatively in the off-pump group.
Hoel
Tom N
TN
Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway. tom.nilsen.hoel@rikshospitalet.no
Videm
Vibeke
V
Mollnes
Tom E
TE
Saatvedt
Kjell
K
Brosstad
Frank
F
Fiane
Arnt E
AE
Fosse
Erik
E
Svennevig
Jan L
JL
D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass; D003167:Complement Activation; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D005112:Extracorporeal Circulation; D006331:Heart Diseases / Q000601:surgery*; D006355:Heart-Lung Machine; D006801:Humans; D018375:Neutrophil Activation; D015539:Platelet Activation