Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemic inflammatory response, usually related to postoperative acute lung injury (ALI). As an attempt to dampen inflammatory response, steroids have been perioperatively administered to patients. Macrophage migration inhibitory factor (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating levels of MIF, 6 hours post CPB. Experimental data have shown that steroids may induce MIF secretion by mononuclear cells. This study aims to correlate levels of MIF assayed 6 hours post CPB to the intensity of postoperative pulmonary dysfunction, analysing the impact of perioperative steroid administration. MethodsWe included patients submitted to cardiac surgery with CPB, electively started in the morning, performed by the same team under a standard technique except for the addition of methylprednisolone (15 mg/kg) to the CPB priming solution for patients from group MP (n = 37), but not for the remaining patients -group NS (n = 37). MIF circulating levels were assayed at the anesthesia induction, 3, 6, and 24 hours after CPB. A standard weaning protocol with fast track strategy was adopted, and indicators of organ dysfunction and therapeutic intervention were registered during the first 72 hours postoperative.Results Levels of MIF assayed 6 hours post CPB correlated directly to the postoperative duration of mechanical ventilation (P = 0.014, rho = 0.282) and inversely to PaO 2 /FiO 2 ratio (P = 0.0021, rho = -0.265). No difference in MIF levels was noted between the groups. The duration of mechanical ventilation was higher (P = 0.005) in the group MP (7.92 ± 6.0 hours), compared with the group NS (4.92 ± 3.6 hours). ConclusionCirculating levels of MIF assayed 6 hours post CPB are correlated to postoperative pulmonary performance. Immunosuppressive doses of methylprednisolone did not affect circulating levels of MIF and may be related to prolonged mechanical ventilation. ResultsFourteen patients (12 males, 56.9 ± 10 years) with severe HF (LV EF 30 ± 6%) were enrolled. All patients had triple-vessel disease and 64% had previous myocardial revascularization. A total of 30 × 10 6 BM-MNC were injected at 15 sites. All patients were discharged from hospital 48 hours after the procedure. The estimated LV ischemic area on MIBI SPECT was measured by percentual of myocardial defect reverse, 14.8 ± 15% of LV mass at baseline that was reduced to 5 ± 11% (P = 0.009) at 8 weeks after S2 procedure. EF increased 16% (P = 0.03) at 8 weeks. The number of PVC was reduced at 24 hours (483 ± 4598 versus 236 ± 6243, P = not significant) and at 8 weeks (483 ± 4598 versus 191 ± 1236, P = not significant). No MA were documented at 24 hours or at 8 weeks. QT dispersion decreased from 63 ± 24 ms at baseline to 54 ± 16 ms (P = 0.3) at 2 months of follow-up.Conclusion BM-MNC transplantation into myocardium of patients with severe heart failure was safely performed and short term follow-up...

No abstract

No abstract