Thorac Cardiovasc Surg 2000; 48(6): 364-369
DOI: 10.1055/s-2000-8352
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Reduced Expression of Systemic Proinflammatory Cytokines after Off-Pump versus Conventional Coronary Artery Bypass Grafting

C. Schulze, N. Conrad, A. Schütz, K. Egi, H. Reichenspurner, B. Reichart, S. M. Wildhirt, C. Schulze, N. Conrad, A. Schütz, K. Egi, H. Reichenspurner, B. Reichart, S. M. Wildhirt
  • Department of Cardiac Surgery, Ludwig-Maximilians University, Munich, Germany
Further Information

Publication History

Publication Date:
31 December 2000 (online)

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.

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Stephen M. Wildhirt,M.D. 

Department of Cardiac Surgery Ludwig-Maximilians University

Marchioninistraße 15

81377 München

Germany

Phone: 089-7097-1844

Fax: 089-7097-1848

Email: wildhirt@hch.med.uni-muenchen.de