Off-Pump CABG Surgery Reduces Systemic Inflammation Compared With On-Pump Surgery but Does Not Change Systemic Endothelial Responses

Abstract

Coronary artery bypass graft (CABG) surgery can result in severe postoperative organ failure. During CABG surgery, cardiopulmonary bypass (CPB) with cardiac arrest is often used (on-pump CABG), which often results in a systemic inflammatory response. To reduce this inflammatory response, off-pump CABG was reintroduced, thereby avoiding CPB. There is increasing evidence that the endothelium plays an important role in the pathophysiology of organ failure after CABG surgery. In this study, 60 patients who were scheduled for elective CABG surgery were randomized to have surgery for on-pump or off-pump CABG. Blood was collected at four time points: start, end, 6 h, and 24 h postoperatively. Levels of inflammatory cytokines, soluble adhesion molecules, and angiogenic factors and their receptors were measured in the plasma. No differences were found in preoperative characteristics between the patient groups. The levels of tumor necrosis factor-α, interleukin 10, and myeloperoxidase, but not interleukin 6, were increased to a greater extent in the on-pump CABG compared with off-pump CABG after sternum closure. The soluble endothelial adhesion molecules E-selectin, vascular cell adhesion molecule 1, and intracellular adhesion molecule 1 were not elevated in the plasma during and after CABG surgery in both on-pump and off-pump CABG. Angiopoietin 2 was only increased 24 h after surgery in both on-pump and off-pump CABG. Higher levels of sFlt-1 were found after sternum closure in off-pump CABG compared with on-pump CABG. Avoiding CPB and aortic cross clamping in CABG surgery reduces the systemic inflammatory response. On-pump CABG does not lead to an increased release of soluble endothelial adhesion molecules in the circulation compared with off-pump CABG.

The Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

“…Just after starting the operation, the plasma levels of myeloperoxidase, tumor necrosis factor-α and interleukin 10 were increased in the on-pump CABG compared with offpump CABG (14). There are also some studies related to the relationship between the development of systemic inflammatory response syndrome and cardiopulmonary bypass revealed that increased RDW is associated with increased systemic inflammatory response (15).…”

Systemic angiopoietin-1/2 dysregulation following cardiopulmonary bypass in adults

“…Uchida et al interestingly reported in his series that the 31 patients with off-pump coronary artery bypass grafting had no changes in their immediate postoperative Ang-2, compared with baseline [17]. In contrast, two recent works comparing on-pump (nonpulsatile) to off-pump (pulsatile) patients, found no significant differences in Ang1 and Ang2 levels, despite a more severe systemic inflammation on-pump [23,29]. It then confirms the incrimination of CPB in the induction of systemic inflammation, but raises the question about its unique contribution to Angiopoietin release.…”

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

“…Studies that evaluated the circulating levels of proinflammatory cytokines (IL‐6, ‐8, and ‐10) after off‐ and on‐pump‐ surgery reported contradictory results 14, 18, 19, 20, 21, 22…”