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Comparison of inflammatory responses after off-pump and on-pump coronary surgery using surface modifying additives
Janine M Quaniers1, Julie Leruth, Adelin Albert
1Department of Surgery, Biostatistics, University of Liège, Liège, Belgium.
The Annals of Thoracic Surgery
|April 25, 2006
Summary
On-pump cardiac surgery using surface modifying additives (SMA) circuits did not increase inflammatory markers more than off-pump surgery, except for complement and elastase levels. This challenges the view that off-pump is always superior for reducing inflammation.
Area of Science:
- Cardiovascular Surgery
- Inflammation Biology
- Biomaterials Science
Background:
- Cardiac surgery often induces harmful inflammation.
- Off-pump coronary bypass surgery is preferred to minimize extracorporeal circulation (EC) effects.
- The study investigates if different EC modalities impact inflammatory responses.
Purpose of the Study:
- To compare the inflammatory response between on-pump and off-pump coronary bypass surgery.
- To evaluate the effect of surface modifying additives (SMA) in EC circuits.
- To determine if EC modalities challenge the preference for off-pump surgery.
Main Methods:
- Four patient groups underwent coronary surgery: on-pump EC with closed/open SMA circuits, and off-pump with different heparin doses.
- Inflammatory markers including interleukins (IL)-6, IL-8, IL-10, myeloperoxidase, elastase, and terminal complement complex (TCC) were measured.
- Measurements were taken at multiple time points: induction, after heparin, after revascularization, after protamine, and 24 hours post-surgery.
Main Results:
- Terminal complement complex (TCC) was significantly higher in both on-pump groups post-revascularization.
- Elastase levels were significantly elevated in the on-pump groups compared to off-pump.
- Interleukin-6 (IL-6) and myeloperoxidase showed no significant differences across the groups.
Conclusions:
- On-pump surgery with SMA-coated circuits did not induce a greater inflammatory response than off-pump surgery, except for complement activation and elastase.
- These findings suggest that advanced EC circuits may mitigate some inflammatory consequences of on-pump cardiac surgery.
- The study provides evidence that challenges the absolute preference for off-pump surgery solely based on inflammatory response when using modified circuits.