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Endothelial dysfunction following coronary artery bypass grafting

Influence of patient and procedural factors
  • J. Hadem
  • R. Rossnick
  • B. Hesse
  • M. Herr
  • M. Hansen
  • A. Bergmann
  • G. Kensah
  • C. Maess
  • H. Baraki
  • P. Kümpers
  • A. Lukasz
  • I. Kutschka
Original articles



Angiopoietin-2 (Angpt2) mediates endothelial dysfunction (ED) following coronary artery bypass grafting (CABG). Its triggers are, however, poorly understood.


We examined the time course of ED beyond the early phase of postoperative recovery in 75 patients following CABG with a special focus on different cardiopulmonary bypass (CPB) modes as potential triggers of Angpt2 release.


Nine patients (12.0%) underwent off-pump coronary artery bypass (OPCAB), 31 patients (41.3%) received minimized extracorporeal circulation (MECC), and 35 patients (46.6%) were operated on with (conventional) CPB. Angpt2 levels steadily increased across the observation period (1.7 [1.4–2.1] to 3.4 [2.5–6.1] ng/ml, p < 0.001). Angpt2 levels did not differ between the MECC and CPB groups (p = 0.564). There was no difference between MECC and CPB patients regarding net fluid balance (p = 0.821) and other surrogate markers of postoperative ED. The magnitude of Angpt-2 increase correlated more strongly with baseline C‑reactive protein (r = 0.459, p < 0.001) than with any other parameter. Hospital length of stay correlated more strongly with baseline Angpt2 levels (r = 0.512, p = 0.005) than with follow-up Angpt2 levels and appeared not to be influenced by CPB mode (p = 0.428).


CABG is associated with prolonged ED, which is determined by the patient’s preoperative inflammatory state rather than by CPB modifications.


Aortocoronary bypass Cardiopulmonary bypass Angiopoietin-2 Endothelium Inflammation 





body mass index


coronary artery bypass grafting


cardiopulmonary bypass


C-reactive protein


intensive care unit


length of stay


minimized extracorporeal circulation


off-pump coronary artery bypass


sequential organ failure assessment


white blood cell count

Endotheliale Dysfunktion nach koronarer Bypass-Operation

Einfluss von Patientenfaktoren und Operationstechnik



Angiopoietin-2 (Angpt2) führt zur endothelialen Dysfunktion (ED) nach Koronararterien-Bypass-Operation (CABG). Über seine Trigger ist jedoch bislang nur wenig bekannt.


Die Autoren untersuchten den Zeitverlauf der ED jenseits der Frühphase der postoperativen Genesung bei 75 Patienten nach CABG mit speziellem Fokus auf den verschiedenen Arten des kardiopulmonalen Bypass (CPB) als potenziellem Trigger der Angpt2-Freisetzung.


Bei 9 Patienten (12,0 %) erfolgte eine CABG ohne Herz-Lungen-Maschine („off-pump coronary artery bypass“, OPCAB), bei 31 Patienten (41,3 %) unter Einsatz der minimierten extrakorporalen Zirkulation („minimized extracorporeal circulation“, MECC) und bei 35 Patienten (46,6 %) mit (konventionellem) CPB. Die Angpt2-Werte stiegen während der Beobachtungsphase ständig an (von 1,7 [1,4–2,1] bis 3,4 [2,5–6,1] ng/ml, p < 0,001). Dabei unterschieden sich die Angpt2-Werte nicht zwischen der MECC- und der CPB-Gruppe (p = 0,564). Auch gab es keinen Unterschied zwischen den Patienten mit MECC und denen mit CPB hinsichtlich der Nettoflüssigkeitsbilanz (p = 0,821) und anderer Surrogatmarker der postoperativen ED. Die Größenordnung des Angpt-2-Anstiegs war stärker mit dem Ausgangswert für C‑reaktives Protein korreliert (r = 0,459; p < 0,001) als mit einem der anderen Parameter. Die Verweildauer im Krankenhaus war stärker mit dem Ausgangswert für Angpt2 korreliert (r = 0,512; p = 0,005) als mit den Folgewerten für Angpt2 und schien nicht durch die Art des CPB beeinflusst zu werden (p = 0,428).


Eine CABG ist mit prolongierter ED assoziiert, die eher durch den präoperativen Entzündungsstatus des Patienten bestimmt wird als durch Modifikationen des CPB.


Aortokoronarer Bypass Kardiopulmonaler Bypass Angiopoietin-2 Endothel Inflammation 



We are grateful for the help of Jan Reck, Tom Kreft, and Christian Ulrich, who assisted in the acquisition of serum samples.

Compliance with ethical guidelines

Conflict of interest

J. Hadem, R. Rossnick, B. Hesse, M. Herr, M. Hansen, A. Bergmann, G. Kensah, C. Maess, H. Baraki, P. Kümpers, A. Lukasz, and I. Kutschka declare that they have no competing interests.

The study adhered to the ethical guidelines of the 1975 Declaration of Helsinki, was approved by the local ethics committee (approval number 51/15), and was registered at the German Clinical Trials Register (DRKS study number 00008855). All patients provided informed consent prior to study entry.

Supplementary material

59_2018_4708_MOESM1_ESM.docx (21 kb)
Listing of significant correlations (Spearman) of Angiopoietin-2 and hospital length of stay with selected patient-inheritant, inflammatory and endothelial markers


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • J. Hadem
    • 1
    • 5
  • R. Rossnick
    • 1
  • B. Hesse
    • 2
  • M. Herr
    • 1
    • 4
  • M. Hansen
    • 3
  • A. Bergmann
    • 3
  • G. Kensah
    • 1
    • 4
  • C. Maess
    • 1
  • H. Baraki
    • 1
    • 4
  • P. Kümpers
    • 2
  • A. Lukasz
    • 2
  • I. Kutschka
    • 1
    • 4
  1. 1.Department of Cardiothoracic Surgery, University ClinicOtto-von-Guericke-UniversitätMagdeburgGermany
  2. 2.Medizinische Klinik DUniversitätsklinikum MünsterMünsterGermany
  3. 3.Klinik für Anästhesiologie und IntensivtherapieOtto-von-Guericke-Universität MagdeburgMagdeburgGermany
  4. 4.Klinik für Thorax‑, Herz- und GefäßchirurgieUniversitätsmedizin GöttingenGöttingenGermany
  5. 5.Department of Gastroenterology and HepatologyUniversity Clinic EssenEssenGermany

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