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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Liebold A., Langhammer Th., Brunger F., Birnbaum D. E.
From the Department of Cardio-Thoracic Surgery University of Regensburg, Regensburg, Germany
Background. Pro-inflammatory cytokines may play an important role in patient response to cardiopulmonary bypass (CPB). Since the myocardium is proposed to be a major source of cytokines, we studied the influence of the cardiolpegia type on interleukin-6 release and early myocardial recovery.
Methods. Experimental design: prospective, randomized study. Setting: university hospital, operative and intensive care. Patients: 20 consecutive patients (3 females) scheduled for elective coronary artery bypass grafting (CABG), mean age 62.8±5 years, history of myocardial infarction 11/20, left ventricular ejection fraction 62.9±15%. Interventions: patients were operated on using randomly either cold blood cardioplegia (B, n=10) or cold crystalloid cardioplegia (C, n=10). Measures: plasma levels of interleukin-6 (IL-6) were measured prior to CPB, after aortic declamping, after CPB, 1 hour, 6 hours and 12 hours postoperatively.
Results. Groups were comparable with respect to demographic data, left ventricular function, number of grafts, CPB and aortic crossclamp time. Group B patients demonstrated significant lower IL-6 levels after 1 hour (210±108 vs 578±443 pg/ml), 6 hours (204±91 vs 1210±671 pg/ml) and 12 hours (174±97 vs 971±623 pg/ml). Post-CPB cardiac index was superior in group B (3.9±0.3 vs 3.2±0.3 l/min/m2, p<0.05) with similar doses of inotropes. Group B patients could earlier be weaned off respirator (10±4 vs 13±4 hours, p<0.05) and showed minor blood loss (635±211 vs 918±347 ml, p<0.05).
Conclusions. Inflammatory response to CPB is associated with delayed myocardial recovery. The use of blood cardioplegia may attenuate inflammatory reactions.