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Off-Pump CABG Surgery Reduces Systemic Inflammation Compared With On-Pump Surgery but Does Not Change Systemic Endothelial Responses: A Prospective Randomized Study

Jongman, Rianne M.*†; Zijlstra, Jan G.; Kok, Wendelinde F.*; van Harten, Annemarie E.*; Mariani, Massimo A.§; Moser, Jill†‡; Struys, Michel M. R. F.*; Absalom, Anthony R.*; Molema, Grietje; Scheeren, Thomas W. L.*; van Meurs, Matijs†‡

doi: 10.1097/SHK.0000000000000190
Clinical Aspects

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.

*Departments of Anaesthesiology, Pathology and Medical Biology, Medical Biology Section, Critical Care, and §Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Received 14 Feb 2014; first review completed 3 Mar 2014; accepted in final form 3 Apr 2014

Address reprint requests to Matijs van Meurs, MD, PhD, Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. E-mail:

Conflict of interest: None declared.

Competing interests: The authors declare that they have no competing interests.

© 2014 by the Shock Society