title: Comparison of inflammatory response following coronary revascularization with or without cardiopulmonary bypass.
abstract: 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.
authors.affiliation: Department of Experimental Surgery, University of Pécs, Medical Faculty, Hungary;
authors.forename: Balázs
authors.initials: B
authors.lastname: Gasz
authors.forename: László
authors.initials: L
authors.lastname: Benkö
authors.forename: Gábor
authors.initials: G
authors.lastname: Jancsó
authors.forename: János
authors.initials: J
authors.lastname: Lantos
authors.forename: Zalán
authors.initials: Z
authors.lastname: Szántó
authors.forename: Nasri
authors.initials: N
authors.lastname: Alotti
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Röth