Preoperative intravenous methylprednisolone (10 mg/ kg) caused a reduction in the serum concentrations of many of these cytokines after CPB, but this reduction was not associ- ated with improved hemodynamic variables, diminished blood loss, less use of inotropic agents, shorter duration of ventilation, or shorter ICU length of stay.63 Similarly, the use of intravenous immunoglobulin G in patients with post-CPB SIRS has not been associated with decreased rates of short- term morbidity or 28-day mortality.64 Other strategies to mitigate the occurrence of SIRS after CPB have been evaluated, including the use of 1) CPB circuits (including oxygenators) coated with materials known to reduce complement and leukocyte activation; 2) CPB tubing that is covalently bonded to heparin; and 3) CPB tubing coated with polyethylene oxide polymer or Poly (2-methoxyethylacrylate). Leukocyte depletion via special- ized filters in the CPB circuits has been shown to reduce the plasma concentrations of P-selectin, intercellular adhesion molecule-1, IL-8, plasma endothelial cell adhesion molecule-1, and plasma malondialdehyde after CPB.65 Finally, closed mini-circuits for CPB have been developed in an attempt to minimize the blood air interface and blood contact with nonbiological surfaces, both of which promote cytokine elaboration, but it is uncertain if these maneuvers and techniques have a discernible effect on outcomes after CABG. 2.1.3. Off-Pump CABG Versus Traditional On-Pump CABG Since the first CABG was performed in the late 1960s, the standard surgical approach has included the use of cardiac arrest coupled with CPB (so-called on-pump CABG), thereby Hillis et al 2011 ACCF/AHA CABG Guideline e659 optimizing the conditions for construction of vascular anas- tomoses to all diseased coronary arteries without cardiac motion or hemodynamic compromise. Such on-pump CABG has become the gold standard and is performed in about 80% of subjects undergoing the procedure in the United States. 