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Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery
Jan Larmann1, Gregor Theilmeier
1Exp-ANIT Entzündung, Klinik und Poliklinik, für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster, Münster, Germany.
Insights
Cardiopulmonary bypass (CPB) triggers significant inflammation, potentially leading to systemic inflammatory response syndrome (SIRS). Off-pump coronary artery bypass grafting (OPCAB) avoids CPB, reducing inflammatory responses and improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Anesthesiology
Background:
- Cardiopulmonary bypass (CPB) has been standard in cardiac surgery since the 1950s.
- CPB induces a significant inflammatory response due to artificial surfaces, ischemia, and hypothermia.
- This inflammation can escalate to systemic inflammatory response syndrome (SIRS), increasing morbidity and mortality.
Purpose of the Study:
- To review the pathophysiology of CPB-induced inflammation.
- To examine anti-inflammatory strategies for CPB.
- To compare clinical evidence between off-pump (OPCAB) and on-pump coronary artery bypass grafting.
Main Methods:
- Literature review of pathophysiological inflammatory mechanisms.
- Analysis of therapeutic anti-inflammatory strategies.
- Comparative evidence synthesis of OPCAB versus conventional CABG.
Main Results:
- CPB triggers a multi-faceted inflammatory cascade.
- Existing anti-inflammatory strategies offer limited control over SIRS.
- OPCAB surgery circumvents CPB-related inflammation, reducing procedural inflammatory stimuli.
Conclusions:
- CPB-induced inflammation poses significant risks in cardiac surgery.
- OPCAB represents a viable alternative to mitigate CPB-associated inflammatory complications.
- Further clinical evidence supports OPCAB for improved patient safety and outcomes.
Abstract:
Cardiac surgery has been routinely performed using cardiopulmonary bypass (CPB) ever since its clinical introduction during the 1950s. CPB is, however, associated with an intense inflammatory response because of conversion to laminar flow, blood contact with the artificial bypass surface, cold cardiac ischaemia and hypothermia. The inflammatory reaction can intensify to a systemic inflammatory response syndrome (SIRS) associated with serious morbidity and mortality. Strategies to suppress inflammation had some success but fell short of controlling SIRS. The development of cardiac immobilization techniques allowing complete revascularization has caused a renaissance of coronary artery bypass grafting surgery on the beating heart (OPCAB). This strategy avoids all inflammation caused by CPB and reduces the pro-inflammatory stimulus to sternotomy and the revascularization procedure itself. This review summarises the pathophysiological features of the inflammatory response to CPB, revisits therapeutic anti-inflammatory strategies designed to suppress CPB-induced inflammation and balances the clinical evidence available comparing off-pump and on-pump revascularization.
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