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The Journal of Cardiovascular Surgery 1999 October;40(5):633-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Cardiac inter­leu­kin-6 ­release and myo­car­dial recov­ery ­after aor­tic cross­clamp­ing. Crystalloid ver­sus ­blood car­di­o­ple­gia

Liebold A., Langhammer Th., Brunger F., Birnbaum D. E.

From the Department of Cardio-Thoracic Surgery University of Regensburg, Regensburg, Germany


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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.

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