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Published on: July 17, 2012
Cytokine responses and myocardial injury in coronary artery bypass grafting
M Wei1, P Kuukasjarvi, J Laurikka
1Division of Cardiovascular Surgery, Tampere University Hospital, Finland.
Insights
Off-pump coronary artery bypass grafting reduces inflammatory cytokine responses and myocardial injury compared to cardiopulmonary bypass. This suggests interventions to lower cytokines may benefit high-risk cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Biochemistry
Background:
- Cardiopulmonary bypass (CPB) can trigger systemic inflammation post-cardiac surgery, potentially leading to complications.
- Understanding the inflammatory and myocardial injury responses is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare cytokine profiles and myocardial injury markers between coronary artery bypass grafting (CABG) with and without CPB.
- To investigate the relationship between cytokine release and myocardial damage.
Main Methods:
- Compared 9 off-pump CABG patients with 13 CPB patients.
- Measured plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, IL-8, and IL-10 at multiple time points.
- Assessed creatine kinase-MB (CK-MB) levels post-operation.
Main Results:
- IL-8 and IL-10 levels were significantly higher in the CPB group post-reperfusion.
- Postoperative CK-MB levels were significantly elevated in the CPB group.
- Cytokine levels demonstrated a correlation with CK-MB values.
Conclusions:
- Off-pump revascularization is linked to attenuated cytokine responses and reduced myocardial injury.
- Myocardial injury, indicated by CK-MB release, correlates with the extent of cytokine release.
- Modulating cytokine responses during cardiac surgery could offer benefits, especially for patients with severe comorbidities.
Objective:
Cardiopulmonary bypass is acknowledged to be one of the major causes of a complex systemic inflammatory response after cardiac surgery, and it may contribute to postoperative complications and even multiple organ dysfunction. We here compared the cytokine responses and the degree of myocardial injury after coronary artery bypass grafting with or without cardiopulmonary bypass.
Methods:
Nine patients underwent off-pump revascularization and 13 with cardiopulmonary bypass. Plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, IL-8 and IL-10 were measured before anesthesia induction, and 5 min, 1, 4, and 20 h after reperfusion to the myocardium. Levels of the MB isoenzyme of creatine kinase (CK-MB) were also measured after the operation.
Results:
Levels of TNF-alpha were low in both groups. A delayed elevation of IL-6 was noted in the off-pump group. IL-8 and IL-10 levels were significantly higher in the CPB than in the off-pump patients after reperfusion (p=0.006 and 0.001 respectively). Postoperative CK-MB levels were significantly higher in the CPB than in the off-pump group (p=0.001). Cytokine levels correlated with CK-MB values.
Conclusion:
The results indicated that off-pump revascularization was associated with reduced cytokine responses and less severe myocardial injury. The degree of myocardial injury, as defined by CK-MB release, correlated with cytokine release. Intervention designed to reduce cytokine responses in cardiac surgery may be advantageous for patients with severe comorbidity.
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