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J Thorac Cardiovasc Surg 2004;127:1624-1631
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Beating heart revascularization with or without cardiopulmonary bypass: Evaluation of inflammatory response in a prospective randomized study

^a Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
^b Centre of Epidemiology and Biostatistics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China

Received for publication August 14, 2003; revisions received September 17, 2003; accepted for publication October 20, 2003.

^* Address for reprints: Ahmed A Arifi, Professor, Chief of Cardiac Surgery, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
arifi64{at}surgery.cuhk.edu.hk

OBJECTIVE: On-pump beating heart coronary artery surgery provides the opportunity to examine the isolated effect of cardiopulmonary bypass. This prospective randomized study compares the early clinical outcomes and inflammatory response of patients undergoing elective on-pump and off-pump beating heart coronary artery bypass grafting.

METHOD AND PATIENTS: Thirty-seven consecutive patients undergoing elective coronary artery bypass grafting were recruited from a pool of 73 patients, with 19 patients randomized to on-pump beating heart surgery and 18 patients to off-pump coronary bypass surgery. Intraoperative events and postoperative outcomes were recorded. Plasma levels of interleukin-6, interleukin-8, and interleukin-10, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 were measured before the operation, intraoperatively, after the operation, and 4, 24, and 48 hours thereafter.

RESULTS: There was no significant difference in clinical outcomes between the 2 groups. The operating time was longer and consumption of platelets was greater for the on-pump beating heart group. There was no postoperative mortality or major complication in either group. There was significant elevation in the levels of interleukin-6, interleukin-8, and interleukin-10 and tumor necrosis factor-alpha during and immediately after the operations in the on-pump beating heart group when compared with the off-pump group. Levels of interleukin-8 (P = .01) and tumor necrosis factor-alpha (P = .0004) remained significantly elevated 4 hours after the operation in the on-pump beating heart group. The level of vascular adhesion molecule dropped significantly during the operation but was elevated 4 hours (P = .026) after the operation in the on-pump beating heart group.

CONCLUSION: The use of cardiopulmonary bypass alone without global myocardial ischemia secondary to aortic crossclamping and cardioplegic cardiac arrest can trigger intense inflammatory responses.

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