ABSTRACT
S ince the introduction of the extra-corporeal circulation (ECC) in the late fifties, its use has been seen as a necessary evil to perform surgery on the heart. The systemic inflammatory reaction generated under cardiopulmonary bypass (CPB) is thought to be responsible for the so-called “reperfusion syndrome” causing, to some extent, the general organ dysfunction encountered after on-pump surgery.1 This is considered to be a major player in post-operative morbidity and prolonged post-operative length of hospital stay. Besides trigger ing the activation of leucocytes, complement, and the release of pro-inflammatory cytokines, ECC also affects nitric oxide metabolism, and can promote oxidative stress injury through the release of oxygen free radicals.2-4 Avoiding ECC may decrease these effects but not eradicate them. The single act of splitting the sternum and entering the mediastinal cavity is, per se, already a major biological aggression. The purpose of this chapter is to review the potential benefit of off-pump surgery on organ dysfunction and peri-operative morbidity in regard to the surgery-related inflammatory reaction.
