Comparison of inflammatory response following coronary revascularization with or without cardiopulmonary bypass.
BACKGROUND
It is well known that conventional coronary revascularization is associated with a pronounced systemic inflammatory response due to the application of cardiopulmonary bypass (CPB).


OBJECTIVE
To compare the effects of coronary artery bypass grafting (CABG) with (on-pump) or without (off-pump) extra-corporeal circulation observing certain inflammatory response parameters.


METHODS
TWENTY PATIENTS UNDERGOING CABG WITH (CPB GROUP: 10 patients) or without (off-pump coronary artery bypass grafting [OPCAB] group: 10 patients) CPB were enrolled in this prospective, randomized study. Blood samples were collected three times during the operation and on postoperative days 1, 2, 3 and 7. The plasma level of proinflammatory cytokine tumor necrosis factor (TNF)-alpha was measured by enzyme-linked immunosorbent assay method following stimulation, and the expression of adhesion molecules (CD11, CD18) of leukocytes were determined by flow cytometry. Furthermore, white blood cell (WBC) and neutrophil count were carried out.


RESULTS
The WBC and neutrophil counts rose markedly in both groups following the operation and remained at this increased level during the observation period. There was a significant difference in WBC and neutrophil counts between the two groups of patients on postoperative day 7. A significant difference in the level of TNF-alpha was found between the two groups on postoperative day 2 (P<0.05). An intense increase was observed with CPB, which significantly exceeded the values of the OPCAB group without extracorporeal circulation in the early postoperative period. The CD11a and CD18 expression of leukocytes decreased during the operation and on postoperative day 1; thereafter, it increased markedly. There was a significant difference in adhesion molecule expression between the two groups on postoperative day 2.


CONCLUSIONS
The investigation revealed that inflammatory response reactions following extracorporeal circulation could be reduced significantly using the off-pump technique.
Gasz
Balázs
B
Department of Experimental Surgery, University of Pécs, Medical Faculty, Hungary;
Benkö
László
L
Jancsó
Gábor
G
Lantos
János
J
Szántó
Zalán
Z
Alotti
Nasri
N
Röth
Erzsébet
E