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Effects of pulsatile CPB on interleukin-8 and endothelin-1 levels
Akira Sezai1, Motomi Shiono, Kin-ichi Nakata
1Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai@med.nihon-u.ac.jp
Insights
Pulsatile cardiopulmonary bypass (CPB) demonstrated reduced inflammatory markers, lower catecholamine levels, and improved respiratory function compared to nonpulsatile CPB in coronary artery bypass grafting patients.
Area of Science:
- Cardiovascular Surgery
- Physiology
- Immunology
Background:
- The optimal method for cardiopulmonary bypass (CPB) remains debated, with ongoing research into pulsatile versus nonpulsatile perfusion.
- Previous studies have not definitively concluded which perfusion method is superior for patient outcomes.
Purpose of the Study:
- To investigate the effects of pulsatile cardiopulmonary bypass (CPB) on inflammatory markers, vasoactive substances, and organ functions.
- To compare pulsatile CPB with nonpulsatile CPB in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Twenty-four patients undergoing CABG were randomized into pulsatile CPB and nonpulsatile CPB groups.
- Key parameters assessed included hemodynamics, cytokines (IL-8), endothelin-1 (ET-1), catecholamines, renal function markers, and respiratory index.
Main Results:
- Pulsatile CPB significantly reduced interleukin-8 (IL-8) and endothelin-1 (ET-1) levels post-procedure.
- Lower levels of epinephrine and norepinephrine were observed in the pulsatile CPB group.
- The pulsatile group exhibited a significantly higher respiratory index, suggesting improved pulmonary function.
Conclusions:
- Pulsatile CPB demonstrates inhibitory effects on cytokine activity and reduces endothelial damage.
- Favorable effects on catecholamine levels, renal function, and peripheral circulation were observed with pulsatile CPB.
- Pulsatile CPB may offer advantages over nonpulsatile perfusion in CABG patients.
Abstract:
Studies on pulsatile and nonpulsatile perfusion have long been performed. However, investigators have not reached a conclusion on which is more effective. In the present study, pulsatile cardiopulmonary bypass (CPB) was investigated in terms of the effects on cytokines, endothelin, catecholamine, and pulmonary and renal functions. Twenty-four patients who underwent coronary artery bypass grafting were divided into a pulsatile CPB group and a nonpulsatile CPB group. Parameters examined were hemodynamics, interleukin-8 (IL-8), endothelin-1 (ET-1), epinephrine, norepinephrine, lactate, arterial ketone body ratio, urine volume, blood urea nitrogen, creatinine, renin activity, angiotensin-II, lactate dehydrogenase, plasma-free hemoglobin, tracheal intubation time, and respiratory index. The IL-8 at 0.5, 3, and 6 h after CPB, and ET-1 at 3, 6, 9, and 18 h after CPB were significantly lower in the pulsatile group. Both epinephrine and norepinephrine were significantly lower in the pulsatile group. The respiratory index was significantly higher in the pulsatile group. In the present study, inhibitory effects on cytokine activity, edema in pulmonary alveoli, and endothelial damage were shown in addition to the favorable effects on catecholamine level, renal function, and peripheral circulation that have already been documented.
