Background. This prospective randomized study compared the inflammatory response in patients undergoing elective on-pump and off-pump coronary artery bypass grafting. Patients and methods. Forty-four patients undergoing elective coronary artery bypass grafting were recruited with 22 patients randomized to on-pump heart surgery and 22 patients to off-pump coronary bypass surgery. Plasma levels of C3bc, the terminal SC5b-9 complement complex, myeloperoxidase, β -thromboglobulin and prothrombin fragment F1 + 2 were measured before the operation, intraoperatively, at termination of the operation, and two hours post-operatively. Results. Complement was markedly activated in the on-pump group as indicated by a significant increase in C3bc and SC5b-9 (p < 0.001 for both), whereas no complement activation was seen in the off-pump group (p = 0.001 between the groups). In contrast, both groups showed significant activation of neutrophils, platelets and coagulation, as indicated by an early increase in myeloperoxidase and a post-operative increase in β-thromboglobulin and F1 + 2, respectively. Notably, there were no inter-group differences with regard to neutrophil and platelet activation, whereas coagulation activation was more pronounced in the off-pump group (p < 0.01). Conclusions. Off-pump surgery completely eliminated the heart-lung machine-induced complement activation. Neutrophils and platelets were equally activated in both groups, whereas coagulation was enhanced post-operatively in the off-pump group.Perfusion (2007) 22, 251—256.
Get full access to this article
View all access options for this article.
References
1.
Kirklin JK, Westaby S., Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico ADComplement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg1983 Dec; 86(6): 845—57.
2.
Chenoweth DE , Cooper SW, Hugli TE, Stewart RW, Blackstone EH, Kirklin JWComplement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins. N Engl J Med1981 Feb 26; 304(9): 497—503.
3.
Moat NE, Shore DF, Evans TWOrgan dysfunction and cardiopulmonary bypass: the role of complement and complement regulatory proteins. Eur J Cardiothorac Surg1993; 7(11): 563—73.
4.
Despotis GJ, Avidan MS, Hogue CW, Jr.Mechanisms and attenuation of hemostatic activation during extra-corporeal circulation. Ann Thorac Surg2001 Nov; 72(5): S1821—S1831.
5.
Videm V., Mollnes TE, Bergh K., Fosse E., Mohr B., Hagve TA et al. Heparin-coated cardiopulmonary bypass equipment. II. Mechanisms for reduced complement activation in vivo. J Thorac Cardiovasc Surg1999 Apr; 117(4): 803—9.
6.
Bucerius J., Gummert JF, Walther T. et al. Impact of off-pump coronary bypass grafting on the prevalence of adverse perioperative outcome in women undergoing coronary artery bypass grafting surgery. Ann Thorac Surg2005 Mar; 79(3): 807—12.
7.
Gobran SR, Goldman S., Ferdinand F. et al. Outcomes after usage of a quality initiative program for off-pump coronary artery bypass surgery: a comparison with on-pump surgery. Ann Thorac Surg2004 Dec; 78(6): 2015—21.
8.
Ascione R., Caputo M., Angelini GDOff-pump coronary artery bypass grafting: not a flash in the pan. Ann Thorac Surg2003 Jan; 75(1): 306—13.
9.
Gu MD P. , Mariani MD P., van Oeveren PhD W., Grandjean Md P., Boonstra Md P.Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting. Ann Thorac Surg1998 Feb; 65(2): 420—4.
Murphy GJ, Angelini GDSide effects of cardiopulmonary bypass: what is the reality?J Card Surg2004 Nov; 19(6): 481—8.
12.
Fosse E., Mollnes TE, Ingvaldsen B.Complement activation during major operations with or without cardiopulmonary bypass. J Thorac Cardiovasc Surg1987 Jun; 93(6): 860—6.
13.
Mollnes TE, Lea T., Harboe M.Detection and quantification of the terminal C5b-9 complex of human complement by a sensitive enzyme-linked immunosorbent assay. Scand J Immunol1984 Aug; 20(2): 157—66.
14.
Garred P., Mollnes TE, Lea T.Quantification in enzyme-linked immunosorbent assay of a C3 neoepitope expressed on activated human complement factor C3. Scand J Immunol1988 Mar; 27(3): 329—35.
15.
Mollnes TE, Lea T., Froland SS, Harboe M.Quantification of the terminal complement complex in human plasma by an enzyme-linked immunosorbent assay based on monoclonal antibodies against a neoantigen of the complex. Scand J Immunol1985 Aug; 22(2): 197—202.
16.
Videm V., Nilsson L., Venge P., Svennevig JLReduced granulocyte activation with a heparin-coated device in an in vitro model of cardiopulmonary bypass. Artif Organs1991 Apr; 15(2): 90—5.
17.
Mollnes TE, Videm V., Christiansen D., Bergseth G., Riesenfeld J., Hovig T.Platelet compatibility of an- artificial surface modified with functionally active heparin. Thromb Haemost1999 Sep; 82(3): 1132—6.
18.
Altman DGPractical statistics for medical research. Chapman & Hall, London1996, pp. 326—31.
19.
Sellke FW, DiMaio JM, Caplan LR et al. Comparing on-pump and off-pump coronary artery bypass grafting: numerous studies but few conclusions: a scientific statement from the American Heart Association council on cardiovascular surgery and anesthesia in collaboration with the interdisciplinary working group on quality of care and outcomes research . Circulation2005 May 31; 111(21): 2858—64.
20.
Mollnes TE, Videm V., Riesenfeld J. et al. Complement activation and bioincompatibility. The terminal complement complex for evaluation and surface modification with heparin for improvement of biomaterials. Clin Exp Immunol1991 Oct; 86 Suppl (1): 21—6.
21.
Wagner JL, Hugli TERadioimmunoassay for anaphylatoxins: a sensitive method for determining complement activation products in biological fluids. Anal Biochem1984 Jan; 136(1): 75—88.
22.
Videm V., Svennevig JL, Fosse E., Semb G., Osterud A., Mollnes TEReduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. J Thorac Cardiovasc Surg1992 Apr; 103(4): 806—13.
23.
Mariani MA, Gu YJ, Boonstra PW, Grandjean JG, van Oeveren W., Ebels T.Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?Ann Thorac Surg1999 May 1; 67(5): 1370—75.
24.
Englberger L., Immer FF, Eckstein FS, Berdat PA, Haeberli A., Carrel TPOff-pump coronary artery bypass operation does not increase procoagulant and fibrinolytic activity: preliminary results . Ann Thorac Surg2004 May; 77(5): 1560—66.
