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J Thorac Cardiovasc Surg 2005;130:1226
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Evaluation of surgical trauma and cardiopulmonary bypass as factors in inflammatory status after cardiac surgery

Cardiac Services Department, North West Armed Forces Hospital, Tabuk, Saudi Arabia

To the Editor:

I read with interest Prondzinsky and colleagues' article ¹ "Surgical Trauma Affects the Proinflammatory Status After Cardiac Surgery to a Higher Degree Than Cardiopulmonary Bypass." Because there was no control group, cardiopulmonary bypass was considered as the sole factor in development of generalized inflammatory response after open procedures. In the past decade, coronary revascularization without cardiopulmonary bypass has become an alternative to the conventional on-pump technique. Patients operated on with this technique thus could represent a control group. Several studies have shown no difference between on-pump and beating-heart surgery with respect to oxygen metabolism after surgery, pulmonary dysfunction, and other aspects. ^2,3,4 Different factors may play a role in development of postoperative inflammatory response, including surgical trauma itself, heparin use, anesthetic challenges, use of suction devices, and perioperative stress. Prondzinsky and colleagues ¹ in their study supported the opinion that the cardiopulmonary bypass is not the sole factor in generation of postoperative inflammatory response. More large, randomized trials studying different inflammatory pathways are still required to confirm this finding.

References

1. Prondzinsky R, Knüpfer A, Loppnow H, Redling F, Lehmann DW, Stabenow I, et al. Surgical trauma affects the proinflammatory status after cardiac surgery to a higher degree than cardiopulmonary bypass. J Thorac Cardiovasc Surg 2005;129:760-766.[Abstract/Free Full Text]
   
2. Parolari A, Alamanni F, Juliano G, Polvani G, Roberto M, Veglia F, et al. Oxygen metabolism during and after cardiac surgery. role of CPB. Ann Thorac Surg 2003;76:737-743.[Abstract/Free Full Text]
   
3. Montes FR, Maldonado JD, Paez S, Aviza F. Off-pump versus on-pump coronary artery bypass surgery and postoperative pulmonary dysfunction. J Cardiothorac Vasc Anesth 2004;18:698-703.[Medline]
   
4. Cheng DC, Bainbridge D, Martin JE, Novick RJ. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass?. A meta-analysis of randomized trials. Anesthesiology 2005;102:188-203.
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Elsayed M. Elmistekawy Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Elmistekawy, E. M. Search for Related Content PubMed PubMed Citation Articles by Elmistekawy, E. M. Related Collections Related Article