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The Journal of Cardiovascular Surgery 2000 December;41(6):819-27


language: English

Effect of normothermic versus hypothermic cardiopulmonary bypass on cytokine production and platelet function

Speziale G., Ferroni P. *, Ruvolo G. **, Fattouch K. **, Pulcinelli F. M. *, Lenti L. *, Gazzaniga P. P. *, Marino B. **

From the Department of Cardiac Surgery Villa Azzurra, Rapallo (GE) *Department of Experimental Medicine and Pathology **Department of Cardiac Surgery University of Rome “La Sapienza”, Rome, Italy


Background. Proinflammatory cyto­kines and plate­lets ­play a key ­role in the system­ic inflam­ma­to­ry ­response asso­ciat­ed ­with car­di­o­pul­mo­nary ­bypass (CPB). The aim of ­this ­study was to eval­u­ate the ­effects of ­both hypo­ther­mic and nor­mo­ther­mic CPB on plate­let acti­va­tion, cyto­kine pro­duc­tion, as ­well as ­their pos­sible cor­re­la­tions.
Methods. Twenty ­patients who under­went ­CABG ­were ran­dom­ly ­assigned ­into two ­groups receiv­ing hypo­ther­mic and nor­mo­ther­mic CPB. Blood sam­ples ­were ­obtained ­through a ­venous cath­e­ter at 6 ­time ­points. The fol­low­ing param­e­ters ­were meas­ured: in ­vitro plate­let aggre­ga­tion, in ­vivo plate­let acti­va­tion, com­plete and dif­fe­ren­tial ­blood ­cell ­counts, plas­ma sol­u­ble P-selec­tin lev­els, plas­ma IL-6, IL-1β and TNFα lev­els.
Results. The ­results dem­on­strat­ed ­that plate­let abnor­mal­ities ­could be ­observed to a great­er ­extent dur­ing hypo­ther­mic rath­er ­than nor­mo­ther­mic CPB. The occur­rence of in ­vivo plate­let acti­va­tion was sug­gest­ed by the pres­ence of a sig­nif­i­cant­ly ­increased per­cent­age of plate­lets express­ing CD62P on ­their sur­face, as ­well as by a ­decreased in ­vitro plate­let aggre­ga­tion ­induced by dif­fer­ent ago­nists. Complete and dif­fe­ren­tial ­blood ­cell ­counts ­showed no sub­stan­tial ­decrease in plate­let num­ber with­out dif­fer­enc­es ­between ­groups. The ­results ­obtained ­also ­showed the pres­ence of a sig­nif­i­cant ­release of sP-selec­tin dur­ing CPB, as ­well as a ­more pro­nounced ­increase of plas­ma sP-selec­tin lev­els in ­patients under­go­ing hypo­ther­mic com­pared to nor­mo­ther­mic CPB. A com­par­i­son of cyto­kine lev­els dem­on­strat­ed a sig­nif­i­cant ele­va­tion of plas­ma IL-6 lev­els dur­ing ­either hypo­ther­mic or nor­mo­then­mic CPB, par­allel­ing the neu­troph­il ­rise, ­while no dif­fer­enc­es ­were ­observed for TNF-α lev­els. Conversely, plas­ma IL-1β lev­els ­were sig­nif­i­cant­ly ele­vat­ed dur­ing hypo­ther­mic, but not dur­ing nor­mo­ther­mic CPB.
Conclusions. Hypothermic CPB is respon­sible for a great­er plate­let acti­va­tion and endo­the­lial dys­func­tion ­than nor­mo­ther­mic CPB, lead­ing to ­more pro­found chang­es in the hemo­stat­ic and inflam­ma­to­ry ­systems, ­which, in turn, ­might be respon­sible for the high­er inci­dence of post­op­er­a­tive com­pli­ca­tions report­ed dur­ing hypo­ther­mic CPB.

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