Free accessResearch articleFirst published online 2005-3
Equivalence of the Acute Cytokine Surge and Myocardial Injury after Coronary Artery Bypass Grafting with and without a Novel Extracorporeal Circulation System
Cardiopulmonary bypass (CPB) contributes to a morbidity-inducing systemic Inflammatory response after cardiac surgery. We compared this response in patients receiving coronary artery bypass grafting (CABG) with (CPB group; n = 7) or without (off-pump group; n = 8) the Minimal Extracorporeal Circulation (MECC®) system. Serum concentrations of tumour necrosis factor (TNF)-α, soluble TNF receptors, pro- and anti-inflammatory interleukins (ILs) and other myocardial injury markers were measured after anaesthetic induction, at 1 h, 4 h and 24 h after completing all anastomoses or serially. Soluble TNF receptor type I (sTNFRI) and IL-8 peaked early after CABG in both groups and did not decline. Serum sTNFRI was significantly higher in the CPB compared with the off-pump group at 1 h, whereas IL-8 was significantly lower in the CPB group throughout. The MECC® system, therefore, produces an equivalent acute cytokine response and degree of myocardial injury to off-pump CABG, and may be useful when CABG cannot be performed without CPB.
OhataTSawaYKadobaKMasaiTIchikawaHMatsudaH: Effect of cardiopulmonary bypass under tepid temperature on inflammatory reactions. Ann Thorac Surg1997; 64: 124–128.
2.
EdmundsLHJr: Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg1998; 66 (suppl 5): S12–S16.
3.
AsimakopoulosGTaykorKM: Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules. Ann Thorac Surg1998; 66: 2135–2144.
4.
MoenOHogasenKFosseEDregelidEBrockmeierVVengeP: Attenuation of changes in leukocyte surface markers and complement activation with heparin-coated cardiopulmonary bypass. Ann Thorac Surg1997; 63: 105–111.
5.
GottJPCooperWASchmidtFEJrBrownWMWrightCEMerlinoJD: Modifying risk for extracorporeal circulation: Trial of four anti-inflammatory strategies. Ann Thorac Surg1998; 66: 747–753.
6.
HortonSBButtWWMullalyRJThuysCAO'ConnorEBByronK: IL-6 and IL-8 levels after cardiopulmonary bypass are not affected by surface coating. Ann Thorac Surg1999; 68: 1751–1755.
7.
AscioneRLloydCTGomesWJCaputoMBryanAJAngeliniGD: Beating versus arrested heart revascularization: Evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg1999; 15: 685–690.
8.
BuffoloEde AndradeCSBrancoJNTelesCAAguiarLFGomesWJ: Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg1996; 61: 63–66.
9.
PoirierNCCarrierMLesperanceJCoteGPellerinMPerraultLP: Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass. J Thorac Cardiovasc Surg1999; 117: 292–297.
10.
WanSIzzatMBLeeTWWanIYTangNLYimAP: Avoiding cardiopulmonary bypass in multi-vessel CABG reduces cytokine response and myo-cardial injury. Ann Thorac Surg1999; 68: 52–57.
11.
MatataBMSosnowskiAWGalinanesM: Offpump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg2000; 69: 785–791.
12.
WeiMKuukasjarviPLaurikkaJKaukinenSIisaloPLaineS: Cytokine responses and myocardial injury in coronary artery bypass grafting. Scand J Clin Lab Invest2001;61: 161–166.
13.
GulielmosVMenschikowskiMDillHEllerMThieleSTugtekinSM: Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting - a prospective randomized comparison of the conventional and three minimally invasive surgical techniques. Eur J Cardiothorac Surg2000; 18: 594–601.
14.
DiegelerADollNRauchTHabererDWaltherTFalkV: Humoral immune response during coronary artery bypass grafting. A comparison of limited approach, ‘off-pump’ technique, and conventional cardiopulmonary bypass. Circulation2000; 102 (suppl 3): 95–100.
15.
SchulzeCConradNSchutzAEgiKReichenspurnerHReichartB: Reduced expression of systemic proinflammatory cytokines after off-pump versus conventional coronary artery bypass grafting. Thorac Cardiovasc Surg2000; 48: 364–369.
16.
EnglbergerLKipferBBerdatPANydeggerUECarrelTP: Aprotinin in coronary operation with cardiopulmonary bypass: Does ‘low-dose’ aprotinin inhibit the Inflammatory response?Ann Thorac Surg2002; 73: 1897–1904.
17.
AscioneRLloydCTUnderwoodMJLottoAAPitsisAAAngeliniGD: Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg2000; 69: 1198–1204.
18.
ChelloMMastrorobertoPQuirinoACudaGPerticoneFCirilloF: Inhibition of neutrophil apoptosis after coronary bypass operation with cardiopulmonary bypass. Ann Thorac Surg2002; 73: 123–130.
19.
GormleySMMcBrideWTArmstrongMAMcCleanEMacGowanSWCampalaniG: Plasma and urinary cytokine homeostasis and renal function during cardiac surgery without cardiopulmonary bypass. Cytokine2002; 17: 61–65.
20.
FransenEMaessenJDentenerMSendenNGeskesGBuurmanW: Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest1998; 113: 1290–1295.
21.
BrasilLAGomesWJSalomaoRBuffoloE: Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg1998; 66: 56–59.
22.
WestabyS: Organ dysfunction after cardiopulmonary bypass. A systemic inflammatory reaction initiated by the extracorporeal circuit. Intensive Care Med1987; 13: 89–95.
23.
DowningSWEdmundsLHJr: Release of vasoactive substances during cardiopulmonary bypass. Ann Thorac Surg1992; 54: 1236–1243.
24.
BaigrieRJLamontPMDallmanMMorrisP: The release of interleukin-1 beta precedes that of interleukin-6 in patients undergoing normothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg1994; 108: 636–641.
RuvoloGGrecoESpezialeGTritapepeLMerinoBMollaceV: Nitric oxide formation during cardiopulmonary bypass. Ann Thorac Surg1994; 57: 1055–1057.
27.
Ungureanu-LongroisDBalligandJLKellyRASmithTW: Myocardial contractile dysfunction in the systemic Inflammatory response syndrome: Role of a cytokine-inducible nitric oxide synthase in cardiac myocytes. J Mol Cell Cardiol1995; 27: 155–167.
28.
KubesPSuzukiMGrangerDN: Nitric oxide: An endogenous modulator of leukocyte adhesion. Proc Natl Acad Sci U S A1991; 88: 4651–4655.
29.
NiuXFSmithCWKubesP: Intercellular oxidative stress induced by nitric oxide synthesis inhibition increases endothelial cell adhesion to neutrophils. Circ Res1994; 74: 1133–1140.
30.
HarigFFeyrerRMahmoudFOBlumUvon der EmdeJ: Reducing the post-pump syndrome by using heparin-coated circuits, steroids or aprotin-in. Thorac Cardiovasc Surg1999; 47: 111–118.
31.
FromesYGaillardDPonzioOChauffertMGerhardtMFDeleuzeP: Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg2002; 22: 527–533.
32.
Van ZeeKJKohnoTFischerERockCSMoldawerLLLowrySF: Tumor necrosis factor soluble receptors circulate during experimental and clinical inflammation and can protect against excessive tumor necrosis factor alpha in vitro and in vivo. Proc Natl Acad Sci USA1992; 89: 4845–4849.
33.
WeisMWildhirtSSchulzeC: Modulation of coronary vasomotor tone by cytokines in cardiac transplant recipients. Transplantation1999; 68: 1263–1267.
34.
EngelbertsIStephensSFrancotGJvan der LindenCJBuurmanWA: Evidence for different effects of soluble TNF-receptors on various TNF-measurements in human biological fluids. Lancet338: 515–516.
35.
FongYLowrySF: Tumor necrosis factor in the pathophysiology of infection and sepsis. Clin Immunol Immunopathol1990; 55: 157–170.
36.
HatoriNYoshizuHHagaYKusamaYTakeshimaSSegawaD: Biocompatibility of heparin-coated membrane oxygenator during cardiopulmonary bypass. Artif Organs1994; 18: 904–910.
37.
GuYvan OeverenWAkkermanCBoonstraPWHuyzenRJWildevuurCR: Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass. Ann Thorac Surg1993; 55: 917–922.
38.
FinnANaikSKleinNLevinskyRJStrobelSElliottM: Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass. J Thorac Cardiovasc Surg1993; 105: 234–241.
39.
RollinsBJ: Chemokines. Blood1997; 90: 909–928.
40.
IveyCLWilliamsFMCollinsPDJosePJWilliamsTJ: Neutrophil chemoattractants generated in two phases during reperfusion of ischemic myocardium in the rabbit: Evidence for a role for C5a and interleukin-8. J Clin Invest1995; 95: 2720–2728.
41.
KukielkaGLSmithCWLaRosaGJManningAMMendozaLHDalyTJ: Interleukin-8 gene induction in the myocardium after ischemia and reperfusion in vivo. J Clin Invest1995; 95: 89–103.
42.
WanSDeSmetJMBarvaisLGoldsteinMVincentJLLeClercJL: Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg1996; 112: 806–811.
43.
NeumannFJOttIGawazMRichardtGHolzapfelHJochumM: Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation1995; 92: 748–755.
KawamuraTNaraNKadosakiMInadaKEndoS: Prostaglandin E1 reduces myocardial reperfusion injury by inhibiting proinflammatory cytokines production during cardiac surgery. Crit Care Med2000; 28: 2201–2208.
46.
MarkewitzAFaistELangSHultnerLWeinholdCReichartB: An imbalance in T-helper cell subsets alters immune response after cardiac surgery. Eur J Cardiothorac Surg1996; 10: 61–67.
47.
BaumanHGauldieJ: The acute phase response. Immunol Today1994; 15: 74–80.
48.
BartonBEJacksonJV: Protective role of interleukin-6 in the lipopolysaccharide-galactosamine septic shock model. Infect Immun1993; 61: 1496–1499.
49.
VertreesRTaoWKramerGCNuttLMcDanielLBDeVineSD: Tumor necrosis factor monoclonal antibody prevents alteration in leukocyte populations during cardiopulmonary bypass. ASAIO J1994; 40: 554–559.
50.
KawamuraTWakusawaROkadaKInadaS: Elevation of cytokines during open heart surgery with cardiopulmonary bypass: Participation of interleukin-8 and 6 in reperfusion injury. Can J Anaesth1993; 40: 1016–1021.
51.
HayashiYSawaYFukuyamaNNakazawaHMatsudaH: Inducible nitric oxide production is an adaptation to cardiopulmonary bypass-induced inflammatory response. Ann Thorac Surg2001; 72: 149–155.
