SYSTEMIC INFLAMMATION PRESENT IN PATIENTS UNDERGOING CABG WITHOUT EXTRACORPOREAL-CIRCULATION

Study objectives: This study was conducted to evaluate to what extent the cardiopulmonary bypass (CPB) procedure in patients undergoing coro nary artery bypass grafting (CABG) contributes to the systemic inflamm atory response. Therefore, we measured bactericidal permeability incre asing protein (BPI) as an indicator of neutrophil activation, interleu kin 6 as inducer of the acute phase response, and lipopolysaccharide b inding protein and C-reactive protein as parameters of the acute phase response in patients undergoing CABG either with or without the use o f CPB, Design: Prospective study. Setting: Cardiopulmonary surgery dep artment in a university hospital, Patients: Sixteen patients undergoin g elective CABG were included. Eight patients underwent surgery with C PB, and eight patients underwent surgery without CPB (non-CPB), Interv entions: In the CPB group, blood samples were taken upon induction of anesthesia, at the start of aortic cross-clamping, at aortic unclampin g, and 0.5, 4, 8, and 18 h thereafter. In the non-CPB group, blood sam ples were taken upon induction of anesthesia, and 0.5, 4, 8, and 18 h after completion of the bypass graft anastomoses. Measurements and res ults: BPI release from neutrophil granules markedly increased during s urgery in CPB patients but not in non-CPB patients. The increase in ac ute phase reactants, however, was the same in both patient groups. Con clusions: These data indicate that the acute phase response in CABG pa tients, which has historically been ascribed to the CPB procedure, is predominantly caused by the surgical procedure per se. Early neutrophi l activation, however, is seen only when extracorporeal circulation is used.