Systemic inflammation after on-pump and off-pump coronary bypass surgery: a one-month follow-up.

BACKGROUND: This study sought to assess inflammation activation in the follow-up (up to one month) of coronary bypass surgery performed both on- (CABG) and off-pump (OPCAB).

METHODS: Thirty patients, candidates for coronary surgery, were randomized to undergo CABG (n = 16) or OPCAB (n = 14). Blood samples were collected before the intervention, after protamine administration, and 4, 8, and 30 days after surgery.

RESULTS: Plasma tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels significantly increased with respect to baseline from protamine administration up to eight postoperative days, whereas high-sensitivity C-reactive protein (hs-CRP) and fibrinogen increased after surgery up to eight postoperative days in both groups. On the other hand, neutrophil elastase levels were higher than baseline from protamine administration up to four postoperative days in CABG, and at the time point eight days after surgery in OPCAB. The only significant differences between CABG and OPCAB in inflammatory markers occurred intraoperatively, after protamine administration, when TNF-alpha and elastase levels were higher in CABG, whereas no differences were detected between CABG and OPCAB at any postoperative time point. Postoperative increases in fibrinogen and hs-CRP were positively correlated with increases in IL-6, but not with postoperative changes in TNF-alpha both in CABG and OPCAB.

CONCLUSIONS: After coronary bypass surgery, there is a protracted postoperative activation of inflammation persisting several days after surgery; this postoperative activation is not affected by the surgical strategy (on-pump or off-pump).