Anti-inflammatory response and cardiopulmonary bypass.

We read with a great interest the excellent article by Onorati and co-workers demonstrating that pulsatile cardiopulmonary bypass (PCPB) and off-pump coronary artery bypass (OPCAB) surgery markedly reduced endothelial activation and inflammatory response as compared with linear CPB [1]. What about anti-inflammatory cytokines (except interleukin (IL)-10 already investigated in this study)? Studies have demonstrated that both inflammatory/anti-inflammatory cytokines and growth factors/antigrowth factors are released during conventional CPB [2—5]. Anti-inflammatory cytokines and anti-growth factors (sFlt-1) are considered as an anti-inflammatory response against CPB-induced inflammatory changes. The authors might use their collected blood samples to search for IL-4, IL-13, soluble IL-6 receptor and soluble vascular endothelial growth factor (VEGF) receptor (sFlt-1) and to identify whether the anti-inflammatory response is also impaired during PCPB and OPCAB as compared with linear CPB.