Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress

Biglioli, P

doi:10.1016/s1010-7940(03)00295-1

Cited by 209Cardiac and Coronary Surgery TechniquesBlood transfusion and managementTransplantation: Methods and Outcomes

Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress

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Biglioli, P·2003·European Journal of Cardio-Thoracic Surgery

DOI 10.1016/s1010-7940(03)00295-1

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Abstract

Cardiopulmonary bypass (CPB) has been recognized as a cause of complex systemic inflammatory response, which significantly contributes to several adverse postoperative complications. In the last few years, off-pump coronary artery bypass grafting has gained widespread diffusion as an alternative technique to conventional on-pump coronary artery bypass grafting. Surgeons supporting off-pump surgery state that the avoidance of the CPB and myocardial ischemia-reperfusion significantly reduces the postoperative systemic inflammatory response and other biological derangements and, possibly, may improve the clinical outcomes. We review, here, the available evidence concerning possible differences between off-pump and on-pump procedures in terms of inflammation, hemostasis and oxidative stress. Consistent differences in the involvement of these systems are observed, but they are limited to the final steps of the surgical procedures and the early hours after. These findings suggest that the global surgical trauma may be as important, or even more, as the CPB in terms of systemic inflammatory and coagulation-fibrinolytic pathway activation. Further studies are needed in order to confirm this hypothesis.

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Nonrandomized studies have shown a marked difference in complement activation (C3a, C5a) between on-pump and off-pump CPB patients.
“Nonrandomized studies have shown a marked difference in complement activation (C3a, C5a) between on-pump and off-pump CPB patients [7].”
From Oral neutrophils are an independent marker of the systemic inflammatory response after cardiac bypass (2014) · cites this paper as [7]

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The puzzle of depression and acute coronary syndrome: Reviewing the role of acute inflammation
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N-acetylcysteine for prevention of acute renal failure in patients with chronic renal insufficiency undergoing cardiac surgery: A prospective, randomized, clinical trial*
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Increased prothrombotic state lasting as long as one month after on-pump and off-pump coronary surgery
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Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery
Hall, R. N. (2012) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2012.09.013 · Cited by 87 · see citing works
Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response
Onorati, F., Rubino, A. S., Nucera, S., FOTI, D. P., Sica, V., Santini, F., Gulletta, E., & Renzulli, A. (2009) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2009.11.010 · Cited by 87 · see citing works
Perioperative Oxidative Stress: The Unseen Enemy
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Off-Pump CABG Surgery Reduces Systemic Inflammation Compared With On-Pump Surgery but Does Not Change Systemic Endothelial Responses
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Does Off-Pump Coronary Surgery Reduce Postoperative Acute Renal Failure? The Importance of Preoperative Renal Function
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Antifibrinolytic Agents in Cardiac and Noncardiac Surgery: A Comprehensive Overview and Update
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Isoprostanes and Oxidative Stress in Off-Pump and On-Pump Coronary Bypass Surgery
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The impact of different biocompatible coated cardiopulmonary bypass circuits on inflammatory response and oxidative stress
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Tranexamic Acid Reduces Blood Loss After Off-Pump Coronary Surgery
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Inflammatory Activation During Coronary Artery Surgery and Its Dose-Dependent Modulation by Statin/ACE-Inhibitor Combination
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Antioxidant defence during cardiopulmonary bypass surgery
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Cardiac surgery as a stressor and the response of the vulnerable older adult
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Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo)
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Coagulation and fibrinolytic protein kinetics in cardiopulmonary bypass
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Oxidative Stress Increased in Healthcare Workers Working 24-Hour On-Call Shifts
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Predictors of Acute Renal Dysfunction After Ventricular Assist Device Placement
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Opposite changes of ADAMTS‐13 and von Willebrand factor after cardiac surgery
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Tranexamic Acid Reduces Blood Loss in Off-Pump Coronary Artery Bypass Surgery
Taghadomi, R. J., Asadollah, M., Attar, A. S., & Shirdel, A. (2008) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2008.09.018 · Cited by 48 · see citing works
The impact of different biocompatible coated cardiopulmonary bypass circuits on inflammatory response and oxidative stress
Sohn, N., Marcoux, J., Mycyk, T. R., Krahn, J., Meng, Q., Gourlay, T., & Shedden, L. (2010) · Perfusion · doi:10.1177/0267659110381453 · Cited by 48 · see citing works
Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention
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Oxygenator Is the Main Responsible for Leukocyte Activation in Experimental Model of Extracorporeal Circulation: A Cautionary Tale
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Functional Renal Outcome in On-Pump and Off-Pump Coronary Revascularization: A Propensity-Based Analysis
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Biomarker Profile in Off-Pump and On-Pump Coronary Artery Bypass Grafting Surgery in Low-Risk Patients
Castellheim, A. G., Hoel, T. N., Videm, V., Fosse, E. T., Pharo, A. M., Svennevig, J. L., Fiane, A. E., & Mollnes, T. E. (2008) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2008.03.012 · Cited by 45 · see citing works
Effect of low-dose ketamine on inflammatory response in off-pump coronary artery bypass graft surgery
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Depression, C-reactive protein and length of post-operative hospital stay in coronary artery bypass graft surgery patients
Poole, L., Kidd, T., Leigh, E. S., Ronaldson, A., Jahangiri, M., & Steptoe, A. (2013) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2013.11.008 · Cited by 42 · see citing works
Quantitative and Temporal Differences in Coagulation, Fibrinolysis and Platelet Activation after On-Pump and Off-Pump Coronary Artery Bypass Surgery
Vallely, M. P., Bannon, P. G., Bayfield, M. S., Hughes, C. F., & Kritharides, L. (2008) · Heart Lung and Circulation · doi:10.1016/j.hlc.2008.08.012 · Cited by 41 · see citing works
Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17 Studies
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Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report
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Effects of Renin-Angiotensin System Inhibitors on the Occurrence of Acute Kidney Injury Following Off-Pump Coronary Artery Bypass Grafting
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Intraoperative Transit Time Flow Measurement: Off-Pump Versus On-Pump Coronary Artery Bypass
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Attachment anxiety predicts IL-6 and length of hospital stay in coronary artery bypass graft surgery (CABG) patients
Kidd, T., Poole, L., Leigh, E. S., Ronaldson, A., Jahangiri, M., & Steptoe, A. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.06.002 · Cited by 34 · see citing works
The relation between intensity and complexity of coronary artery lesion and oxidative stress in patients with acute coronary syndrome
Turan, T., Menteşe, Ü., Ağaç, M. T., Akyüz, A. R., Kul, S., Aykan, A. Ç., Bektas, H., Korkmaz, L., Menteşe, S. Ö., Dursun, İ., et al. (2014) · The Anatolian Journal of Cardiology · doi:10.5152/akd.2014.5761 · Cited by 33 · see citing works
The relationship between oxidative stress and coronary artery ectasia.
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The combined use of neutrophil gelatinase-associated lipocalin and brain natriuretic peptide improves risk stratification in pediatric cardiac surgery
Cantinotti, M., Storti, S., Lorenzoni, V., Arcieri, L., Moschetti, R., Murzi, B., Spadoni, I., Passino, C., & Clerico, A. (2012) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2012-0125 · Cited by 32 · see citing works
Biomarkers in Coronary Artery Bypass Surgery: Ready for Prime Time and Outcome Prediction?
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Intraoperative Moderate Acute Normovolemic Hemodilution Associated with a Comprehensive Blood-Sparing Protocol in Off-Pump Coronary Surgery
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Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement
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The role of tissue factor and P-selectin in the procoagulant response that occurs in the first month after on-pump and off-pump coronary artery bypass grafting
Parolari, A., Mussoni, L., Frigerio, M., Naliato, M., Alamanni, F., Polvani, G., Agrifoglio, M., Veglia, F., Tremoli, E., Biglioli, P., et al. (2005) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2005.07.049 · Cited by 28 · see citing works
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On- and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization
Alamanni, F., Dainese, L., Naliato, M., Gregu, S., Agrifoglio, M., Polvani, G., Biglioli, P., & Parolari, A. (2008) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2008.03.031 · Cited by 28 · see citing works
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Tranexamic acid attenuates early post-operative systemic inflammatory response and nutritional loss and avoids reduction of fibrinogen in total hip arthroplasty within an enhanced recovery after surgery pathway
Changjun, C., Xin, Z., Luo, Y., Chengcheng, Z., Qiuru, W., Li, Q., & Pengde, K. (2021) · International Orthopaedics · doi:10.1007/s00264-021-05182-3 · Cited by 27 · see citing works
Significance of Oxidants and Inflammatory Mediators in Blood of Patients Undergoing Cardiac Surgery
Elahi, M. M., Yii, M. Y., & Matata, B. M. (2008) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2007.12.022 · Cited by 27 · see citing works
The long pentraxin 3 in cardiac surgery: Distinct responses in “on-pump” and “off-pump” patients
Kunes, P., Lonský, V., Manďák, J., Koláčková, M., Andrýs, C., Kudlová, M., & Krejsek, J. (2007) · Scandinavian Cardiovascular Journal · doi:10.1080/14017430701324262 · Cited by 27 · see citing works
Surgical nurse assistants in cardiac surgery: a UK trainee's perspective
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Alterations in biomarkers of endothelial function following on‐pump coronary artery revascularization
Panagiotopoulos, I. A., Palatianos, G. M., Michalopoulos, A. S., Chatzigeorgiou, A., Prapas, S. N., & Kamper, E. F. (2010) · Journal of Clinical Laboratory Analysis · doi:10.1002/jcla.20416 · Cited by 25 · see citing works
Inflammatory response and platelet activation after off-pump coronary artery bypass surgery
Aljassim, O., Karlsson, M., Wiklund, L., Jeppsson, A., Olsson, P., & Berglin, E. (2005) · Scandinavian Cardiovascular Journal · doi:10.1080/14017430500381307 · Cited by 25 · see citing works
Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: a randomised clinical trial
Liu, H., Lu, F.-X., Zhou, J., Yan, F., Qian, S.-C., Li, X., Zheng, S., Chen, J.-Q., Zhong, J., Feng, Q., et al. (2018) · Heart · doi:10.1136/heartjnl-2017-312793 · Cited by 24 · see citing works
Emergency preservation and delayed resuscitation allows normal recovery after exsanguination cardiac arrest in rats: A feasibility trial*
Drábek, T., Stezoski, J. P., Garman, R. H., Wu, X., Tisherman, S. A., Stezoski, S. W., Fisk, J. A., Jenkins, L. W., & Kochanek, P. M. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000253398.61666.0d · Cited by 24 · see citing works
The Importance of Intraoperative Selenium Blood Levels on Organ Dysfunction in Patients Undergoing Off-Pump Cardiac Surgery: A Randomised Controlled Trial
Stevanovic, A., Coburn, M., Menon, A. K., Rossaint, R., Heyland, D. K., Schälte, G., Werker, T., Wonisch, W., Kiehntopf, M., Goetzenich, A., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104222 · Cited by 23 · see citing works
Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study
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The Early Inflammatory Response in a Mini–Cardiopulmonary Bypass System a Prospective Randomized Study
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PANCREATIC CELLULAR INJURY AFTER CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS
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Assessment of oxidative stress in coronary artery bypass surgery: comparison between the global index OXY-SCORE and individual biomarkers
Veglia, F., Werba, J. P., Tremoli, E., Squellerio, I., Sisillo, E., Parolari, A., Minardi, F., & Cavalca, V. (2009) · Biomarkers · doi:10.3109/13547500903134395 · Cited by 22 · see citing works
Vasoplegic Syndrome in Cardiac Surgery: A Narrative Review of Etiologic Mechanisms and Therapeutic Options
Polyak, P., Kwak, J., Kertai, M. D., Anton, J. M., Assaad, S. I., DaCosta, M., Dimitrova, G. T., Gao, W. D., Henderson, R. A., Hollon, M., et al. (2025) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2025.02.047 · Cited by 22 · see citing works
Admission Levels of C-Reactive Protein and Plasminogen Activator Inhibitor-1 in Patients With Acute Myocardial Infarction With and Without Cardiogenic Shock or Heart Failure on Admission
Akkuş, M. N., Polat, G., Yurtdaş, M., Akçay, B., Erçetin, N., Çiçek, D., Döven, O., & Sucu, N. (2009) · International Heart Journal · doi:10.1536/ihj.50.33 · Cited by 21 · see citing works
Proteomic Analysis of Plasma from Patients Undergoing Coronary Artery Bypass Grafting Reveals a Protease/Antiprotease Imbalance in Favor of the Serpin α1-Antichymotrypsin
Banfi, C., Parolari, A., Brioschi, M., Barcella, S., Loardi, C. M., Centenaro, C., Alamanni, F., Mussoni, L., & Tremoli, E. (2010) · Journal of Proteome Research · doi:10.1021/pr901079v · Cited by 19 · see citing works
Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study
Paulitsch, F. D. S., Schneider, D. J., Sobel, B. E., Rached, R. D. V. A., Ramires, J. A. F., Jatene, F. B., Stolf, N. A. G., Hueb, W. A., & Lopes, N. H. M. (2009) · Coronary Artery Disease · doi:10.1097/mca.0b013e3283219e8b · Cited by 19 · see citing works
Carvedilol versus Metoprolol for the Prevention of Atrial Fibrillation After Off-Pump Coronary Bypass Surgery: Rationale and Design of the Carvedilol or Metoprolol Post-Revascularization Atrial Fibrillation Controlled Trial (COMPACT)
Kamei, M., Morita, S., Hayashi, Y., Kanmura, Y., & Kuro, M. (2006) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-006-8375-7 · Cited by 19 · see citing works
Fibrinolysis in coronary artery surgery: detection by thromboelastography
Vaněk, T., Jares, M., Šnircová, J., & Malý, M. (2007) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1510/icvts.2007.161463 · Cited by 19 · see citing works
Advanced oxidation protein products as prognostic biomarkers for recovery from acute kidney injury after coronary artery bypass grafting
Liang, X., Chen, Y., Zhuang, J., Zhang, M., Xiong, W., Guo, H., Jiang, F., Hu, P., Guo, D., & Shi, W. (2012) · Biomarkers · doi:10.3109/1354750x.2012.690103 · Cited by 18 · see citing works
The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery
Antunes, N., Dragosavc, D., Petrucci, O., de Oliveira, P. P. M., Kosour, C., Blotta, M. H. S. L., Braile, D. M., & Vieira, R. W. (2008) · Brazilian Journal of Cardiovascular Surgery · doi:10.1590/s0102-76382008000200005 · Cited by 18 · see citing works
Phosphorylcholine Coating of Bypass Systems Used for Young Infants Does Not Attenuate the Inflammatory Response
Draaisma, A. M., Hazekamp, M. G., Anes, N., Schoof, P. H., Hack, C. E., Sturk, A., & Dion, R. A. E. (2006) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2005.11.058 · Cited by 18 · see citing works
Oral neutrophils are an independent marker of the systemic inflammatory response after cardiac bypass
Wilcox, M. E., Charbonney, E., d’Empaire, P. P., Duggal, A., Pinto, R., Javid, A., Dos Santos, C., Rubenfeld, G. D., Sutherland, S., Liles, W. C., et al. (2014) · Journal of Inflammation · doi:10.1186/s12950-014-0032-5 · Cited by 17 · see citing works
“Nonrandomized studies have shown a marked difference in complement activation (C3a, C5a) between on-pump and off-pump CPB patients [7].”
Background
Clinical Efficacy and Biocompatibility of Three Different Leukocyte and Fat Removal Filters During Cardiac Surgery
de Vries, A. J., Vermeijden, W., Gu, Y., Hagenaars, J. A. M., & van Oeveren, W. (2006) · Artificial Organs · doi:10.1111/j.1525-1594.2006.00241.x · Cited by 16 · see citing works
Antioxidative effects of propofol vs. ketamin in individuals undergoing surgery.
Khoshraftar, E., Ranjbar, A., Kharkhane, B., Tavakol, H. S., Gharebaghi, Z., & Zadkhosh, N. (2014) · PubMed · Cited by 16 · see citing works
Effect of the E-selectin Gene Polymorphism (S149R) on Platelet Activation and Adverse Events After Coronary Artery Surgery
Stępień, E. Ł., Krawczyk, S., Kapelak, B., Sobczyński, R., Stoliński, J., Wypasek, E., Undas, A., & Sadowski, J. (2011) · Archives of Medical Research · doi:10.1016/j.arcmed.2011.07.007 · Cited by 15 · see citing works
Oxidant Status following Cardiac Surgery with Phosphorylcholine‐Coated Extracorporeal Circulation Systems
Hatemi, A. C., Çeviker, K., Tongut, A., Özgöl, İ., Mert, M., & Kaya, A. (2016) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2016/3932092 · Cited by 15 · see citing works
Interplay between platelet and T lymphocyte after coronary artery bypass grafting (CABG): Evidence for platelet mediated post-CABG immunomodulation
Farhid, F., Hosseini, E., Kargar, F., & Ghasemzadeh, M. (2025) · Microvascular Research · doi:10.1016/j.mvr.2025.104805 · Cited by 14 · see citing works
Оксидативный стресс как неспецифический фактор патогенеза органных повреждений (обзор литературы и собственных исследований)
Lysenko, V. I. (2020) · EMERGENCY MEDICINE · doi:10.22141/2224-0586.16.1.2020.196926 · Cited by 14 · see citing works
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Authors: Biglioli, P.
Affiliations: University of Milan (IT)
Corresponding author: Biglioli, P
Venue: European Journal of Cardio-Thoracic Surgery
Publisher: Oxford University Press (OUP)
Published: 2003-08
Volume: 24
Issue: 2
Pages: 260-269
ISSN: 1010-7940 (ISSN-L)
DOI: 10.1016/s1010-7940(03)00295-1
OpenAlex: W2098507195
Cited by: 209
References: 66
Citations by year: 2026: 3 · 2025: 9 · 2024: 9 · 2023: 6 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 7 · 2018: 2 · 2017: 7 · 2016: 11 · 2015: 7 · 2014: 11 · 2013: 5 · 2012: 13
FWCI: 10.55
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: European Journal of Cardio-Thoracic Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Health Sciences › Medicine › Biochemistry › Blood transfusion and management
Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
Keywords: off-pump coronary artery bypass, on-pump coronary artery bypass grafting, cardiopulmonary bypass, systemic inflammatory response, hemostasis, oxidative stress, myocardial ischemia-reperfusion injury, postoperative complications, surgical trauma
MeSH terms: C-Reactive Protein, Cardiopulmonary Bypass, Complement Activation, Coronary Disease, Fibrinolysis, Heart-Assist Devices, Hemostasis, Humans, Inflammation, Interleukins, Leukocytes, Pancreatic Elastase, Platelet Aggregation, Time Factors, Tumor Necrosis Factor-alpha, Biomarkers, Oxidative Stress

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Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress

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