Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

Abstract

Background-The introduction of limited approaches to the heart and the avoidance of cardiopulmonary bypass (CPB) aim to reduce the invasiveness of CABG by decreasing the systemic release of inflammatory cytokines, such as tumor necrosis factor (TNF)-␣, interleukin (IL)-6, and IL-8, as well as the anti-inflammatory agent IL-10. This study compares the humoral immune response in patients undergoing CABG with standard, minimally invasive, and "off-pump" techniques. Methods and Results-Thirty patients were divided into 3 operative groups: full sternotomy approach plus CPB (group A); full sternotomy approach, off pump (group B); and limited left anterior thoracotomy, off pump (group C). Plasma levels of TNF-␣ receptors p55 and p75, IL 6, IL-8, and IL-10 were taken at baseline, during CPB, and at 4, 24, and 48 hours and 6 days after surgery. A significant increased release of activated complement factors C5a and C3d, IL-8, and IL-10 was observed in patients subjected to CPB (group A) during the initial period and for a short time after perfusion (PϽ0.05). TNF-␣ receptors p55 and p75 showed a prolonged elevation (up to 48 hours) in the CPB group compared with the 2 off-pump groups. IL-6 showed no different release among the 3 surgical groups throughout the entire period. There was no significant difference in any parameter measured in relation to the type of operative approach. Conclusions-There is an inflammatory, as well as an anti-inflammatory, response during CABG that is related to the general surgical trauma.

Trimetazidina e resposta inflamatória em cirurgia de revascularização do miocárdio

“…Of the surgical variables analyzed, the ECC time and aortic cross-clamping time were similar between the groups and were also lower than those described in the literature 10,14 . Bucerius et al 15 , in a clinical trial, have recognized the ECC time as an independent predictor of post-operative complications.…”

“…Studies with several protocols have assessed markers involved in the pathophysiology of the inflammatory response, which still lacks effective preventive management. Currently, the substances assessed on trials have not proved to completely reduce the inflammatory complications in CABG-ECC 10,11 .…”

Massive Pulmonary Eden During Extracorporeal Circulation

“…Kompleman aktivasyonu ile aktive olan nötrofillerin pulmoner vasküler yatakta sekestrasyonu ve pulmoner vasküler permeabilitenin artması ile pulmoner interstisyel ödem oluşmakatadır [1][2][3] . Alveoler surfaktanın kompozisyonundaki değişiklikler ile atelektaziler gelişmektedir.…”

“…GiriŞ Pompa akciğeri; açık kalp cerrahisi sonrası immün sistemin aktivasyonu sonucu pulmoner vasküler geçirgenliğin artması, azalmış akciğer kompliyansı, artmış intrapulmoner şant, azalmış rezidüel kapasite, yaygın mükus tıkaçları ve bozulmuş ventilasyon perfüzyon oranı ile görülen klinik bir tablodur [1][2][3] . Açık kalp ameliyatı sonrası gelişen akut respiratuvar distres sendromu, aşırı volüm yüklenmesi ve konjestif kalp yetersizliği gibi tablolarla benzerdir.…”

Endothelial Progenitor Cell Homing Decreases Postoperative Complications in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

“…For example, inflammatory mediators, such as IL-6 and IL-8, peaked at 4-24 hours after surgery (21). Similarly, leukocyte activation, characterized by release of neutrophil elastase, peaked at 4-6 hours (22).…”