Multi-organ failure may occur due to activation of systemic inflammatory process with many other factors in open-heart procedures when cardiopulmonary bypass is used. Activation of systemic inflammatory process may cause postoperative complications. Surgical trauma, contact of blood with foreign surface, endotoxemia and ischemia-reperfusion injury are major factors that contribute to activation of inflammatory response. In this review we purposed to investigate the factors which contribute to the systemic inflammatory process, multiorgan dysfunction and the therapeutic modalities during open heart surgery.