| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2000;17:77-83
© 2000 Elsevier Science NL
a Clinic for Cardiovascular Surgery, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
b Division of Clinical Chemistry, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
c Division of Surgical Research, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
Corresponding author. Tel.: +41-1-255-3801; fax: +41-1-255-4369
e-mail: gregor.zund{at}chi.usz.ch
Objective: Cardiac surgery with cardiopulmonary bypass (CPB) results in expression of cytokines and adhesion molecules (AM) with subsequent inflammatory response. The purpose of the study was to evaluate the clinical impact of modified ultrafiltration (MUF) and its efficacy in reducing cytokines and AM following coronary artery bypass grafting (CABG) in adults. Methods: A prospective randomized study of 97 patients undergoing elective CABG was designed. Fifty patients were operated on using normothermic and 47 patients using hypothermic CPB. The normothermic group was subdivided into a group with modified ultrafiltration (n=30) and a group without MUF (n=20). In the hypothermic group 30 patients received MUF compared to 17 patients serving as controls. MUF was instituted after CPB for 15 min through the arterial and venous bypass circuit lines. Cytokines (IL-6, IL-8, TNF-
, IL-2R) and adhesion molecules (sE-selectin, sICAM-1) were measured preoperatively, pre-MUF, in the ultrafiltrate, 24 h, 48 h and 6 days after surgery by chemiluminescent enzyme immunometric assay or enzyme-linked immunosorbent assay (ELISA). Clinical parameters were collected prospectively until discharge. Results: In all patients AM and cytokines were significantly elevated after normothermic and hypothemic CPB. AM and cytokines were significantly higher in hypothermia compared to normothermia. In hypothermic CPB sE-selectin was decreased after 24 h by 37% (P<0.0063) and by 40% (P<0.0027) after 48 h postoperatively. ICAM-1 was reduced by 43% (P<0.0001) after 24 h and by 60% (P<0.0001) after 6 days. Similar results were seen in cytokines with reduction up to 60% after 24 h. Changes after 48 h were noticeable but not significant. Reduction of AM and cytokines after normothermic CPB was minimal. Neither in normothermia, nor in hypothermia has sIL-2R been effectively removed from the circulation. There were no significant differences in the clinical variables between the patients with or without MUF. Conclusion: AM and cytokines are significantly elevated after hypothermic CPB compared to normothermic CPB. MUF led to a significant reduction in cytokine and AM levels after hypothermic CPB, except for IL-2R. MUF showed minimal effect in normothermia. We conclude that MUF is an efficient way to remove cytokines and AM. However, we were unable to demonstrate any significant impact of MUF in outcome of adults after elective CABG.
Key Words: Cardiac surgery • Modified ultrafiltration • Adhesion molecules • Cytokines • Clinical outcome
This article has been cited by other articles:
|
|
 |
|
  A. Anselmi, G. Possati, and M. Gaudino Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation? Ann. Thorac. Surg., July 1, 2009; 88(1): 326 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Yokoyama, S. Takabayashi, T. Komada, K. Onoda, Y. Mitani, H. Iwata, and H. Shimpo Removal of prostaglandin E2 and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 730 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Perez-Vela, E Ruiz-Alonso, F Guillen-Ramirez, M. Garcia-Maellas, E Renes-Carreno, M Cerro-Garcia, J Cortina-Romero, and I Hernandez-Rodriguez ICU outcomes in adult cardiac surgery patients in relation to ultrafiltration type Perfusion, March 1, 2008; 23(2): 79 - 87. [Abstract] [PDF]
|
|
|
|
|
|
M Buyukates, S Acikgoz, O Kandemir, E Aktunc, E Ceylan, and M Can Use of warm priming solution in open heart surgery: its effects on hemodynamics and acute inflammation Perfusion, March 1, 2008; 23(2): 89 - 94. [Abstract] [PDF]
|
|
|
|
 |
|
 J. W. Hammon Extracorporeal Circulation: The Response of Humoral and Cellular Elements of Blood to Extracorporeal Circulation Card. Surg. Adult, January 1, 2008; 3(2008): 370 - 389. [Full Text]
|
|
|
|
|
|
D. Jegger, J.-P. Revelly, J. Horisberger, L. K. von Segesser, and P. Ruchat Establishing an association between a peri-operative perfusion score system (PerfSCORE) and post-operative patient morbidity/mortality during CPB cardiac surgery Perfusion, September 1, 2007; 22(5): 311 - 316. [Abstract] [PDF]
|
|
|
|
|
|
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Saitoh, M. Tsuchida, T. Koike, K. Satoh, M. Haga, T. Aoki, S.-i. Toyabe, and J.-i. Hayashi Ultrafiltration attenuates cardiopulmonary bypass-induced acute lung injury in a canine model of single-lung transplantation J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1447 - 1454. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Brancaccio, E. Villa, E. Girolami, G. Michielon, C. Feltri, E. Mazzera, D. Costa, G. Isacchi, E. Iannace, A. Amodeo, et al. Inflammatory cytokines in pediatric cardiac surgery and variable effect of the hemofiltration process Perfusion, September 1, 2005; 20(5): 263 - 268. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Tirilomis, M. Friedrich, H. Sirbu, I. Aleksic, and T. Busch Intraoperative Hemofiltration in Adults: Prevention of Hypercirculatory Syndrome? Asian Cardiovasc Thorac Ann, March 1, 2005; 13(1): 17 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Li, A. Hoschtitzky, M. L. Allen, M. J. Elliott, and A. N. Redington An Analysis of Oxygen Consumption and Oxygen Delivery in Euthermic Infants After Cardiopulmonary Bypass With Modified Ultrafiltration Ann. Thorac. Surg., October 1, 2004; 78(4): 1389 - 1396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R de Vroege, F te Meerman, L Eijsman, W R Wildevuur, C. R. Wildevuur, and W van Oeveren Induction and detection of disturbed homeostasis in cardiopulmonary bypass Perfusion, September 1, 2004; 19(5): 267 - 276. [Abstract] [PDF]
|
|
|
|
|
|
P. A. Berdat, E. Eichenberger, J. Ebell, J.-P. Pfammatter, M. Pavlovic, C. Zobrist, E. Gygax, U. Nydegger, and T. Carrel Elimination of proinflammatory cytokines in pediatric cardiac surgery: Analysis of ultrafiltration method and filter type J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1688 - 1696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S Chew Does modified ultrafiltration reduce the systemic inflammatory response to cardiac surgery with cardiopulmonary bypass? Perfusion, January 1, 2004; 19(1_suppl): S57 - S60. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Das and J. Dunning Is prophylactic haemofiltration during cardiopulmonary bypass of benefit during cardiac surgery? Interactive CardioVascular and Thoracic Surgery, December 1, 2003; 2(4): 420 - 423. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Chong, C. R. Hampton, and E. D. Verrier Microvascular Inflammatory Response in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2003; 7(3): 333 - 354. [Abstract] [PDF]
|
|
|
|
|
|
M de Baar, J C Diephuis, K G M Moons, J Holtkamp, R Hijman, and C J Kalkman The effect of zero-balanced ultrafiltration during cardiopulmonary bypass on S100b release and cognitive function Perfusion, January 1, 2003; 18(1): 9 - 14. [Abstract] [PDF]
|
|
|
|
|
|
P. Menasche and L. H. Edmunds Jr. Extracorporeal Circulation: The Inflammatory Response Card. Surg. Adult, January 1, 2003; 2(2003): 349 - 360. [Full Text]
|
|
|
|
|
|
M. S Chew, V. Brix-Christensen, H. B Ravn, I. Brandslund, E. Ditlevsen, J. Pedersen, K. Hjortholm, O. K Hansen, E. Tunnesen, and V. E Hjortdal Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: a prospective, randomized study Perfusion, September 1, 2002; 17(5): 327 - 333. [Abstract] [PDF]
|
|
|
|
|
|
S. C. Stoica, M. Goddard, and S. R. Large The endothelium in clinical cardiac transplantation Ann. Thorac. Surg., March 1, 2002; 73(3): 1002 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Paparella, T.M. Yau, and E. Young Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 232 - 244. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. P. Schurr, G. Zund, S. P. Hoerstrup, J. Grunenfelder, F. E. Maly, P. R. Vogt, and M. I. Turina Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass Ann. Thorac. Surg., October 1, 2001; 72(4): 1316 - 1320. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. B. Luciani, T. Menon, B. Vecchi, S. Auriemma, and A. Mazzucco Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations: A Prospective, Randomized Clinical Trial Circulation, September 18, 2001; 104 (2009): I-253 - I-259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Drabe, G. Zund, J. Grunenfelder, M. Sprenger, S. P. Hoerstrup, L. Bestmann, F. E. Maly, and M. Turina Genetic predisposition in patients undergoing cardiopulmonary bypass surgery is associated with an increase of inflammatory cytokines Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 609 - 613. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Gourlay Biomaterial development for cardiopulmonary bypass Perfusion, September 1, 2001; 16(5): 381 - 390. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
