Off-Pump Coronary Artery Bypass Surgery Is Associated with Reduced Neutrophil Activation as Measured by the Expression of CD11b: A Prospective Randomized Study

  • Sharif Al-Ruzzeh
  • Ginette Hoare
  • Nandor Marczin
  • George Asimakopoulos
  • Shane George
  • Kenneth Taylor
  • Mohamed Amrani


Background: Coronary artery bypass grafting (CABG) surgery is associated with systemic inflammation. Activation of neutrophils is a crucial step in inflammation and results in neutrophil sequestration within the tissues. One of the potential advantages of performing off-pump coronary artery bypass (OPCAB) surgery is the attenuation of the systemic inflammatory response. This prospective randomized study compares neutrophil activation in patients undergoing OPCAB versus those undergoing CABG with cardiopulmonary bypass (CPB).

Methods: Twenty patients undergoing primary isolated CABG were randomly divided prospectively into 2 groups: 1 group underwent CABG with CPB, and the other group underwent OPCAB. Central venous blood samples were obtained before skin incision and at 15 minutes, 60 minutes, 2 hours, 5 hours, and 24 hours following the initiation of CPB or application of the stabilization device. Differential white cell counts were measured with routine laboratory techniques. CD11b surface expression on neutrophils was measured by flow cytometry. Interleukin 8 levels in the plasma were measured by enzyme-linked immunosorbent assays.

Results: The 2 groups were matched with respect to preoperative and operative characteristics. White cell and neutrophil counts rose in both groups following the operation but were significantly higher in the OPCAB group at 5 hours (P < .001 and P = .002, respectively). Interleukin 8 concentrations were significantly higher in the CPB group at 5 hours following the initiation of CPB (P = .034). CD11b levels were significantly higher in the CPB group at 60 minutes (P = .002). Conclusion: This prospective randomized study demonstrates that the activation of circulating neutrophils as measured by CD11b expression is lower following OPCAB than in CPB. Although OPCAB is associated with significantly higher neutrophil counts, these neutrophils exhibit fewer activation markers. The lower postoperative neutrophil counts occurring in the CPB group may be explained by the activation and consequent sequestration of the neutrophils in the CPB circuit and tissues.


Lango R, Anisimowicz L, Siebert J, et al. 2001. IL-8 concentration in coronary sinus blood during early coronary reperfusion after ischemic arrest. Eur J Cardiothorac Surg 20:550-4.\nLe Deist F, Menasche P, Kucharski C, Bel A, Piwnica A, Bloch G. 1995. Hypothermia during cardiopulmonary bypass delays but does not prevent neutrophil-endothelial cell adhesion: a clinical study. Circulation 92(suppl 2):354-8.\nLu H, Smith CW, Perrard J, et al. 1997. LFA-1 is sufficient in mediating neutrophil emigration in Mac-1-deficient mice. J Clin Invest 99:1340-50.\nMatata B, Sosnowski A, Galinanes M. 2000. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg 69:785-91.\nMathew J, Rinder C, Tracey J. 1995. Acadesine inhibits neutrophil CD11b up-regulation in vitro and during in vivo cardiopulmonary bypass. J Thorac Cardiovasc Surg 109:448-56.\nPlow EF, Zhang L. 1997. A MAC-1 attack: integrin functions directly challenged in knockout mice. J Clin Invest 99:1145-6.\nAscione R, Lloyd CT, Gomes WJ, Caputo M, Bryan AJ, Angelini GD. 1999. Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 15:685-90.\nAscione R, Lloyd C, Underwood M, Lotto A, Pitsis A, Angelini G. 2000. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 69:1198-204.\nAsimakopoulos G, Kohn A, Stefanou D, Haskard D, Landis RC, Taylor KM. 2000. Leukocyte integrin expression in patients undergoing cardiopulmonary bypass. Ann Thorac Surg 69:1192-7.\nAsimakopoulos G, Taylor K. 1998. Effects of cardiopulmonary bypass on leukocytes and endothelial adhesion molecules. Ann Thorac Surg 66:2135-44.\nAsimakopoulos G. 1999. Mechanisms of the systemic inflammatory response syndrome. Perfusion 14:269-77.\nBoyle J, Pohlman T, Johnson M, Verrier E. 1997. The systemic inflammatory response. Ann Thorac Surg 64:S31-7.\nBraude S, Nolop KB, Fleming JS, Krausz T, Taylor KM, Royston D. 1986. Increased pulmonary transvascular protein flux after canine cardiopulmonary bypass. Am Rev Respir Dis 134:867-72.\nCzerny M, Baumer H, Kilo J, et al. 2000. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg 17:737-42.\nDiegeler A, Doll N, Rauch T, et al. 2000. Humoral immune response during coronary artery bypass grafting: a comparison of limited approach, "off-pump" technique and conventional cardiopulmonary bypass. Circulation 102(suppl 3):III95-100.\nFrering B, Phillip I, Dehoux M, Rolland C, Langlois J, Desmonts J. 1994. Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 108:636-41.\nJandl JH. 1996. Blood: textbook of hematology. 2nd ed. Boston, Ma: Lippincott Williams & Wilkins. p 615-49.\nJohn A, Galea J, Francis SE, Holt CM, Finn A. 1998. Interleukin-8 mRNA expression in circulating leukocytes during cardiopulmonary bypass. Perfusion 13:409-17.\nKarube N, Adachi R, Ichikawa Y, Kosuge T, Yamazaki I, Soma T. 1996. Measurement of cytokine levels by coronary sinus blood sampling during cardiac surgery with cardiopulmonary bypass. ASAIO J 42:M787-91.\nAlbelda SM, Smith CW, Ward PA. 1994. Adhesion molecules and inflammatory injury. FASEB J 8:504-12.\nSpringer TA. 1994. Traffic signals for lymphocyte recirculation and leukocyte emigration: the multistep paradigm. Cell 76:301-14.\nVan Eeden S, Miyagashima R, Haley L, Hogg J. 1995. L-selectin expression increases on peripheral blood polymorphonuclear leukocytes during active marrow release. Am J Respir Crit Care Med 151:500-7.\nWeiss SJ. 1989. Tissue destruction by neutrophils. N Engl J Med 320:365-76.\nWildhirst S, Schulze C, Conrad N, et al. 2000. Reduced myocardial cellular damage and lipid peroxidation in off-pump versus conventional coronary artery bypass grafting. Eur J Med Res 5:222-8.\n

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