Abstract
Cardiopulmonary bypass (CPB) has long been recognized as being associated with a whole body inflammatory response, which can contribute to post-operative complications [1]. CPB triggers complement activation and the release of endotoxin and cytokines, which in turn may induce cellular activation along with the expression of adhesion molecules, oxygen free radicals, arachidonic acid metabolites, platelet activating factor (PAF), nitric oxide (NO), and endothelins (Fig. 1). These complex interactions may result in bleeding disorders as well as in altered respiratory, renal, neurological, and hepatic functions that could ultimately lead to multiple organ failure (MOF) [1]. Therefore, avoiding the use of CPB (‘off-pump’) is believed to be beneficial, particularly during coronary artery bypass grafting (CABG) [2–4]. Indeed, recent clinical trials have shown that off-pump CABG may reduce post-operative morbidity.
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