Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial function: a prospective randomized study

Objective - Cardiac surgery initiates a systemic inflammatory response, which may affect endothelial function. The aim of this study was to investigate if off-pump CABG ( OPCAB) reduces the postoperative inflammatory response and affects endothelial function less than conventional on- pump CABG. Design - Fifty- two patients submitted for elective CABG were included in a prospective, randomized study. Twenty- six patients were operated with, and 26 without cardiopulmonary bypass ( CPB). Plasma levels of complement ( C3a), cytokines ( IL- 8, TNF-alpha), endothelin- 1 and neopterin were measured before and during surgery and 2 and 24 h after surgery. Endothelial function was assessed by forearm plethysmography and acetylcholine infusion in 30 patients 2 - 4 h after surgery. Results - C3a and neopterin concentrations were significantly higher during and early after surgery in the CPB group while TNF-alpha and IL- 8 tended to be higher in the CPB group but the difference did not reach statistical significance. Endothelial function did not differ significantly between the two groups. Conclusion - OPCAB reduces complement activation compared with on- pump CABG but does not significantly affect TNF-alpha and IL- 8 release or endothelial function.