Background: Both cardiopulmonary bypass (CPB) and operative trauma are associated with increased
expression of proinflammatory cytokines. We assessed the relative contribution of
CPB on activation of various proinflammatory cytokines in patients undergoing coronary
revascularization by comparing them with patients receiving coronary artery bypass
grafts using off-pump (OPCAB) techniques. Methods: Twenty-six patients were assigned to either the OPCAB procedure using a suction device
and regular sternotomy (n = 13) or were treated conventionally using extracorporeal
circulation, blood cardioplegia and hypothermic arrest (29 - 31°C; n = 13). C-reactive
protein and systemic levels of TNF-α, TNF specific receptors Rp1 and Rp2, Interleukin-6
(IL-6) and soluble IL-2 receptors (sIL-2r) were assayed by ELISA or EIA. To account
for systemic nitric oxide production, total nitrate/nitrite (NOx) was measured using
the Griess reaction. Results: Coronary revascularization with CPB was associated with a significant expression increase
in the TNF-system and sIL-2r when compared to the OPCAB patients. Although IL-6 expression
did not differ between both groups, C-reactive protein levels were significantly lower
in the OPCAB group. Moreover, systemic NOx levels as the stable end-product of nitric
oxide were lower in the OPCAB group. Conclusions: The data of the present study indicate that, despite comparable surgical trauma,
the OPCAB revascularization procedure without the use of CPB and cardioplegic arrest
significantly reduces the systemic inflammatory response syndrome and early catecholamine
requirement. This may contribute to improved organ function, subsequently resulting
in improved postoperative recovery from surgical revascularization procedures, particularly
in critically ill patients.
Key words:
OPCAB - Inflammation - Cytokines
References
wildhirt@hch.med.uni-muenchen.de
