| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2005;28:569-575
© 2005 Elsevier Science NL
Original articles |
a Department of Cardiovascular Surgery, Bundeswehr Central Hospital, Rübenacher Str.170, D 56072 Koblenz, Germany
b Department of Thoracic Surgery, Bundeswehr Central Hospital, Koblenz, Germany
c Department of Immunology, Central Institute of the Bundeswehr Medical Service, Koblenz, Germany
d Department of General Surgery, University of Marburg, Marburg, Germany
Received 10 November 2004; received in revised form 20 May 2005; accepted 6 July 2005.
* Corresponding author. Tel.: +49 2631 281 3736; fax: +49 2631 281 3733. (Email: dr.axel.franke{at}t-online.de; axel1franke{at}bundeswehr.org).
Abstract
Objective: Due to the combination of local trauma, extracorporeal circulation (ECC), and pulmonary and myocardial reperfusion, cardiac surgery leads to substantial changes in the immune system and possibly to post-operative complications. Procedures without ECC, however, have failed to demonstrate clear advantages. We hypothesized that ECC is far less important in this context than the reperfusion/reventilation of the lung parenchyma and the surgical trauma. We therefore conducted a prospective observational study to compare immune reactions after cardiac operations with those after thoracic surgery. Methods: Serum levels of pro-inflammatory interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha as well as C-reactive protein (CRP), lipoprotein-binding protein (LBP) and procalcitonin (PCT) were measured pre-operatively (d0), at the end of the operation (dx), 6h after the operation (dx+), on the 1st (d1), 3rd (d3), and 5th (d5) post-operative days in 108 patients (pts) undergoing elective coronary artery bypass grafting (CAB) with ECC (n=42, CPB CAB), off-pump coronary artery bypass surgery (n=24, OP CAB) without ECC or thoracic surgery (n=42, TS). Results: After cardiac surgery (CS), IL-6 and IL-8 increased and reached a maximum on dx+. IL-6 returned to baseline values at d3, whereas IL-8 remained elevated until d5. No difference was found between OP CAB and CPB CAB patients. In the TS patients, IL-6 increased later (dx+) and absolute levels were lower than in the CS patients. No increase in IL-8 was noted in the TS patients. Due to the high variation in the results obtained in all three groups, there was no significant change in TNF-alpha. A comparison of TS, OP CAB, and CPB CAB revealed that the CS patients had higher levels on d0, dx, d3, and d5. Serum levels of CRP, LBP, and IL-2R increased from dx+ to d5 in all groups and reached maximum values on d3. Whereas we found no difference in CRP and IL-2R between the groups, LBP levels were significantly higher from dx+ to d3 after OP CAB. PCT was elevated from dx+ to d3 in all pts. Similar levels were noted for the TS and OP CAB patients. The CPB CAB patients showed the highest levels. Conclusions: Surgical trauma and reperfusion injury appear to represent the predominant factors resulting in immunologic changes after cardiac surgery. Cardiopulmonary bypass (CPB) may be less important for immune response and acute-phase reactions than previously suspected. In addition, our data indicate a relationship between IL-6 synthesis and the degree of surgical trauma. IL-8 appears to be elevated only after cardiac surgery whereas PCT liberation depended on the use of ECC.
Key Words: Inflammatory response • Cardiac and thoracic surgery • Innate immunity • Adaptive immunity
This article has been cited by other articles:
|
|
 |
|
  K. Lehle, J. G. Preuner, A. Vogt, L. Rupprecht, A. Keyser, R. Kobuch, C. Schmid, and D. E. Birnbaum Endothelial cell dysfunction after coronary artery bypass grafting with extracorporeal circulation in patients with type 2 diabetes mellitus Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 611 - 616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pretorius, B. S. Donahue, C. Yu, J. P. Greelish, D. M. Roden, and N. J. Brown Plasminogen Activator Inhibitor-1 as a Predictor of Postoperative Atrial Fibrillation After Cardiopulmonary Bypass Circulation, September 11, 2007; 116(11_suppl): I-1 - I-7. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. An and Y.-B. Xiao Growth hormone prevents acute liver injury induced by cardiopulmonary bypass in a rat model J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 342 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. An and Y.-B. Xiao The preventative role of growth hormone on acute liver injury induced by cardiopulmonary bypass in a rat model Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1037 - 1043. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-W. Wu, H.-L. Kao, M.-F. Chen, B.-C. Lee, W.-Y. I. Tseng, J.-S. Jeng, K.-Y. Tzen, R.-F. Yen, P.-J. Huang, and W.-S. Yang Characterization of Plaques Using 18F-FDG PET/CT in Patients with Carotid Atherosclerosis and Correlation with Matrix Metalloproteinase-1 J. Nucl. Med., February 1, 2007; 48(2): 227 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. von Dossow, N. Baehr, M. Moshirzadeh, C. von Heymann, J. P. Braun, O. V. Hein, M. Sander, K.-D Wernecke, W. Konertz, and C. D. Spies Clonidine Attenuated Early Proinflammatory Response in T-Cell Subsets After Cardiac Surgery Anesth. Analg., October 1, 2006; 103(4): 809 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. M. Bical, Y. Fromes, D. Gaillard, M. Fischer, O. Ponzio, P. Deleuze, M.-F. Gerhardt, and F. Trivin Comparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery. Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 699 - 702. [Abstract] [Full Text] [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 |
