Deleterious effects of cardiopulmonary bypass in coronary artery surgery and scientific interpretation of off‐pump's logic

Abstract

Cardiopulmonary bypass (CPB) has been suggested to be a cause of complex systemic inflammatory response that significantly contributes to several adverse postoperative complications. In the last few years, off-pump coronary artery bypass grafting (OPCAB) has gained widespread attention as an alternative technique to conventional on-pump coronary artery bypass grafting (ONCAB). However, a degree of uncertainty regarding the relative merits of ONCAB and OPCAB continues to be a significant issue. Surgeons supporting off-pump surgery, state that the avoidance of the CPB leads to significantly reduced myocardial ischemia-reperfusion injury, postoperative systemic inflammatory response and other biological derangements, a feature that may improve the clinical outcomes. However, perfection in perioperative care, surgical technique and methods of attenuating the untoward effects of CPB has resulted in better clinical outcome of ONCAB as well. Possible reasons of these controversial opinions are that high-quality studies have not comprehensively examined relevant patient outcomes and have enrolled a limited range of patients. Some studies may have been too small to detect clinically important differences in patient outcomes between these two modalities. We present a review of the available scientific interpretation of the literature on OPCAB with regard to safety, hemodynamic changes, inflammation, myocardial preservation and oxidative stress. We also sought to determine from different reported retrospective and randomized control studies, the initial and the long-term benefits of this approach, despite the substantial learning curve associated with OPCAB.

The combined use of neutrophil gelatinase-associated lipocalin and brain natriuretic peptide improves risk stratification in pediatric cardiac surgery

“…Finally, the independent and signifi cant contribution of CPB time on the prediction of the presence of AKI (Table 4) is largely expected when considering that CPB causes complex systemic infl ammatory responses that signifi cantly contribute to several adverse postoperative complications, including renal damage (30,31) .…”

The effect of melatonin on interleukins 22 and 13 in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass: A Clinical Trial

“…The in ammatory response in cardiac surgery is made by complex interactions with several pathways such as production or activation of complement, neutrophils, thrombin, cytokines, mast cells, and some other multiple in ammatory mediators (28). Mechanisms such as exposure of blood to nonphysiologic surfaces, anesthesia, trauma, body temperature alterations, and ischemia or reperfusion injury may be responsible for these pathological effects (29), which results in immunologic reactions and release proin ammatory cytokines, arachidonic acid metabolites, platelet-activating factors, endothelins, endothelial, and leukocyte adhesion molecules which induce the overproduction of reactive oxygen species (30,31).…”

Inflammatory Response in Patients under Coronary Artery Bypass Grafting Surgery and Clinical Implications: A Review of the Relevance of Dexmedetomidine Use

“…Cardiopulmonary bypass responses have often been compared with the pathophysiologic changes occurring in systemic inflammatory response syndrome (SIRS) [4] and remain not fully understood. Several interlinked mechanisms could play a role in the pathological effects associated with cardiopulmonary bypass, for instance, the exposure of blood to nonphysiologic surfaces, surgical trauma, anesthesia, changes in body temperature, increased intestinal permeability to endotoxins, and ischemia/reperfusion injury [5]. It results in a complex immunologic reaction with the release into circulation of Scheme 1: Cardiopulmonary bypass and the extracorporeal circulation responses with the pathophysiologic changes resembling the systemic inflammatory response syndrome (SIRS).…”