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Off-pump cardiac surgery abolishes complement activation
Tom N Hoel1, Vibeke Videm, Tom E Mollnes
1Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway. tom.nilsen.hoel@rikshospitalet.no
Insights
Off-pump coronary artery bypass grafting (CABG) surgery eliminates heart-lung machine-induced complement activation compared to on-pump CABG. While neutrophil and platelet activation were similar, coagulation was more pronounced in the off-pump group.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Hematology
Background:
- Inflammatory responses are a concern in cardiac surgery.
- On-pump and off-pump coronary artery bypass grafting (CABG) techniques have different procedural implications.
Purpose of the Study:
- To compare the inflammatory response between on-pump and off-pump CABG.
- To investigate the impact of cardiopulmonary bypass on complement activation.
Main Methods:
- Prospective randomized study of 44 patients undergoing elective CABG.
- Patients were randomized to on-pump (n=22) or off-pump (n=22) surgery.
- Plasma markers of complement activation (C3bc, SC5b-9), neutrophil activation (myeloperoxidase), platelet activation (beta-thromboglobulin), and coagulation (F1 + 2) were measured pre-operatively and at multiple post-operative time points.
Main Results:
- On-pump CABG showed significant complement activation (C3bc, SC5b-9; p < 0.001).
- Off-pump CABG demonstrated no significant complement activation (p = 0.001 between groups).
- Both groups exhibited similar neutrophil and platelet activation, but off-pump surgery showed enhanced coagulation (p < 0.01).
Conclusions:
- Off-pump CABG effectively eliminates complement activation associated with the heart-lung machine.
- Neutrophil and platelet activation are comparable between on-pump and off-pump CABG.
- Coagulation activation is more pronounced following off-pump CABG.
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, beta-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 beta-thromboglobulin and F1 + 2, respectively. Notably, there were no intergroup 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.
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