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Eur J Cardiothorac Surg 2004;25:35-42
© 2004 Elsevier Science NL
a Department of Clinical Immunology, Institution of Medicine, Karolinska Institutet, Stockholm, Sweden
b Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden
Received 11 June 2003; received in revised form 16 September 2003; accepted 4 October 2003.
* Corresponding author. Institution of Medicine, Clinical Immunology, Karolinska Hospital, S-171 76 Stockholm, Sweden. Tel.: +46-8-517-76701; fax: +46-8-33-57-24
e-mail: lena.wehlin{at}ks.se
Objective: The aim of this prospective, randomised study was to investigate the influence of extracorporeal circulation on the inflammatory response, our hypothesis being that off pump coronary artery bypass grafting (OFFCAB) procedures would generate less activation than on pump procedures (ONCAB). Methods: Patients admitted for elective CABG were randomised to either ONCAB or OFFCAB surgery and blood samples were taken during and up to 24 h after the operation. We measured complement factors C5a and the terminal complement complex (TCC, C59-b), and the interleukins IL-6 and IL-8. Leukocytes were studied for cellular counts and adhesion molecules (CD11b, CD35 and CD62L) by flow cytometry. We included a combination of activity markers with different aspects of neutrophil function and combined these with in vitro activation. Results: The complement factors C5a and TCC showed a more rapid (P=0.02, P<0.001) and TCC a more profound (P<0.001) increase in the ONCAB group than in the OFFACB group during the operation, after that there were no inter-group differences. Cellular markers, cell counts and interleukin levels were activated by surgery but with no difference between groups. Conclusion: This prospective, randomised study showed less complement activation in low risk OFFCAB, compared to ONCAB patients.
Key Words: Coronary artery bypass • Off pump • Flow cytometry • Inflammation • Complement • Randomised
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