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J Thorac Cardiovasc Surg 2003;125:843-848
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Endotoxemia in coronary artery bypass surgery: A comparison of the off-pump technique and conventional cardiopulmonary bypass

Naz Bige Aydin, MD^a, Hakan Gercekoglu, MD^a, Burak Aksu, MD^b, Vedat Ozkul^c, Tufan Sener, MD^a, lknur Kygl, MD^a, Tansel Turkoglu, MD^a, Serdar Cimen, MD^a, Funda Babacan, MD^b, Murat Demirtas, MD^a

From the Divisions of Cardiovascular Surgery^a and Anesthesiology,^c Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, and Department of Microbiology,^b University of Marmara, Istanbul, Turkey.

Received for publication April 19, 2002. Revisions requested May 28, 2002; revisions received June 6, 2002. Accepted for publication June 24, 2002. Address for reprints: Naz Bige Aydin, MD, Atasehir 67 Ada Kardelen 4-11 D:33 PK:81120 Kadikoy, Istanbul, Turkey (E-mail: bigeaydin{at}ixir.com).

Objectives: The endotoxemia associated with cardiac surgery is thought to be dominantly influenced by the use of cardiopulmonary bypass. The objectives of this study were to assess the relative contribution of cardiopulmonary bypass on endotoxemia apart from cardiac surgical access and to improve our understanding of the potential benefits of off-pump procedures.
Methods: Thirty patients undergoing coronary artery bypass grafting were followed up prospectively. The patients were divided into 2 equal groups: those who underwent bypass grafting through a sternotomy incision without cardiopulmonary bypass (off-pump group) and those who underwent bypass grafting through a sternotomy incision with cardiopulmonary bypass (CPB group). Blood sampling for endotoxin, lactate, and cardiac index measurements were performed during the following time points: (1) after sternotomy; (2) during the coronary occlusion period in the off-pump group and during aortic clamping in the CPB group; (3) after removal of the coronary occlusion sutures in the off-pump group and after removal of the aortic clamp in the CPB group; (4) 30 minutes after the completion of all distal anastomoses in the off-pump group and immediately after weaning from cardiopulmonary bypass in the CPB group; (5) 1 hour postoperatively; and (6) 12 hours postoperatively.
Results: Endotoxin and lactate levels were significantly (P < .05) lower in the off-pump group at all sampling time points, except after sternotomy.
Conclusions: In conclusion, this study has shown that endotoxemia during coronary artery bypass surgery seems mainly to be associated with cardiopulmonary bypass procedure. The relatively lower endotoxin levels observed in off-pump surgery might contribute to improved postoperative recovery.

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