Comparison of inflammatory response during on-pump and off-pump coronary artery bypass surgery.
OBJECTIVE
On-pump coronary artery bypass graft (CABG) surgery has been traditionally associated with a higher magnitude of inflammatory response than off-pump CABG. However with the development of polymer-coated biocompatible extracorporeal circuits, we wanted to see if cardiopulmonary bypass still played an important role in triggering this inflammatory response.


METHODS
In this prospective observational study, 33 patients undergoing CABG surgeries (25 on-pump and 8 off-pump patients) were studied. Serial plasma cytokine (TNF IL-6, IL-10) and procalcitonin concentrations were measured at different time-points during and after the surgery. Demographic and baseline clinical data, intra-operative management details and post-operative complications were also collected from the patients' charts.


RESULTS
Plasma levels of all 4 mediators increased during surgery and returned towards normal postoperatively. There were no differences between groups for any mediator at any time-point.


CONCLUSIONS
We conclude that with the use of recent polymer-coated biocompatible extracorporeal circuits, the inflammatory response triggered by on-pump CABG becomes very similar in magnitude and pattern to that triggered by off-pump CABG. Thus, the surgical procedure contributes to most of the inflammatory response, with the extra-corporeal circuit having minimal to no effect on this response.
Rimmelé
Thomas
T
The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 1526, USA.
Venkataraman
Ramesh
R
Madden
Nicholas J
NJ
Elder
Michele M
MM
Wei
Lawrence M
LM
Pellegrini
Ronald V
RV
Kellum
John A
JA
D000368:Aged; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D020099:Coated Materials, Biocompatible / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood
C000606589:CALCA protein, human; D020099:Coated Materials, Biocompatible; D016207:Cytokines; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide