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Influence of surgical procedures on interleukin-6 and monocyte chemotactic and activating factor responses: CABG vs.
1Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan. kawahito@omiya.jichi.ac.jp
Insights
Cardiac surgery involving valvular procedures leads to higher levels of inflammatory markers Interleukin-6 (IL-6) and monocyte chemotactic and activating factor (MCAF) compared to coronary artery bypass grafting (CABG). These findings highlight the impact of surgical type on systemic inflammation post-cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Inflammation Research
Background:
- Interleukin-6 (IL-6) and monocyte chemotactic and activating factor/monocyte chemoattractant protein-1 (MCAF/MCP-1) are key mediators of inflammation, immune response, and tissue damage following cardiopulmonary bypass (CPB).
- Previous studies indicate variable elevations in IL-6 and MCAF after CPB, suggesting a potential influence of surgical procedures.
- Understanding these cytokine responses is crucial for managing perioperative inflammation in cardiac surgery.
Purpose of the Study:
- To investigate the impact of different surgical procedures on perioperative serum levels of IL-6 and MCAF.
- To compare the release of these proinflammatory cytokines in patients undergoing coronary artery bypass grafting (CABG) versus valvular surgery.
Main Methods:
- A comparative study involving 18 CABG patients and 7 valvular surgery patients.
- Serum concentrations of IL-6 and MCAF were measured using ELISA at multiple time points: pre-anesthesia, aortic declamping, end of CPB, end of surgery, and 24 hours post-surgery.
- Statistical analysis was performed to compare cytokine levels between the two surgical groups.
Main Results:
- Both IL-6 and MCAF levels increased after aortic declamping in both groups, peaking at the end of surgery.
- Serum IL-6 concentrations were significantly higher in the valvular surgery group compared to the CABG group at the end of surgery (123.9 vs. 79.7 pg/ml) and 24 hours post-surgery (113.6 vs. 39.9 pg/ml).
- MCAF levels at the end of surgery were also significantly elevated in the valvular surgery group compared to the CABG group (1118.4 vs. 241.0 pg/ml).
Conclusions:
- IL-6 and MCAF play significant roles in the pathophysiology of surgical trauma associated with CPB.
- The type of cardiac surgical procedure significantly influences the magnitude of proinflammatory cytokine release.
- Valvular surgery appears to elicit a more pronounced inflammatory response compared to CABG.
Abstract:
Interleukin-6 (IL-6) and monocyte chemotactic and activating factor/monocyte chemoattractant protein-1 (MCAF/MCP-1) play pivotal roles in systemic inflammation, immune response, and tissue damage after cardiopulmonary bypass (CPB). Previous reports have described transient rises in IL-6 and MCAF after CPB, but the data seem to vary according to the different surgical procedures used. To evaluate the influence of the different surgical procedures on the proinflammatory cytokine responses, we compared perioperative serum IL-6 and MCAF release in coronary artery bypass grafting (CABG) and valvular surgery cases. Eighteen CABG (CABG group) and 7 single valvular cardiac surgery patients (valve group) were included in this study. Blood samples were taken to measure the serum concentrations of IL-6 at the induction of anesthesia, at the removal of the aortic cross-clamp, at the end of CPB, at the end of surgery, and 24 h after the termination of surgery. Serum IL-6 and MCAF were assayed by ELISA. Serum IL-6 increased immediately after aortic declamping and reached its peak at the end of surgery in both groups. Serum IL-6 concentrations at the end of surgery and 24 h after surgery were significantly higher in the valve group than in the CABG group (123.9 +/- 21.7 pg/ml vs. 79.7 +/- 10.4 pg/ml, p = 0.049; 113.6 +/- 25.0 pg/ml vs. 39.9 +/- 11.5 pg/ml, p = 0.006, respectively). Serum MCAF increased immediately after aortic declamping, and the MCAF level at the end of surgery was significantly higher in the valve group than in the CABG group (1118.4 +/- 353.9 pg/ml vs. 241.0 +/- 71.2 pg/ml, p = 0.002, respectively). IL-6 and MCAF may play important roles in the pathophysiology of surgical damage with CPB, and the different surgical procedures appear to affect the proinflammatory cytokine release after cardiac surgery differently.