Changes in inflammatory and vasoactive mediator profiles during valvular surgery with or without infective...

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Immunology

Background:

• Over 50% of infective endocarditis (IE) patients require surgery.
• Valve surgery in IE patients is linked to high rates of multiple organ dysfunction syndrome (MODS) and mortality.
• Increased inflammatory mediators during cardiopulmonary bypass (CPB) may contribute to adverse outcomes.

Purpose of the Study:

• To compare plasma cytokine profiles in patients undergoing valve surgery with or without IE.
• To investigate the relationship between inflammatory mediators and outcomes in IE patients undergoing surgery.

Main Methods:

• Prospective case-control pilot study.
• Measured plasma inflammatory mediators at 7 time points in 40 patients (20 with IE, 20 controls).
• Assessed MODS using sequential organ failure assessment (SOFA) scores.

Main Results:

• IE patients had higher preoperative SOFA and EuroSCORE II, and greater in-hospital mortality (35% vs. 5%).
• Elevated levels of IL-6, IL-18, MR-proADM, and MR-proANP were observed in IE patients post-CPB.
• IL-1β and TNF-α were detectable only in IE patients after CPB initiation.

Conclusions:

• Infective endocarditis significantly increases the inflammatory response during cardiac valve surgery.
• Higher plasma inflammatory mediator levels in IE patients correlate with increased mortality.
• Targeting the inflammatory response could be a potential therapeutic strategy for IE patients undergoing surgery.