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Intra-aortic balloon pump induced pulsatile perfusion reduces endothelial activation and inflammatory response following cardiopulmonary bypass

^a Cardiac Surgery Unit, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
^b Pathology Unit, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy

Received 23 August 2008; received in revised form 17 November 2008; accepted 22 December 2008.

^_* Corresponding author. Tel.: +39 0961 3697115; fax: +39 0961 3697142. (Email: frankono{at}libero.it).

Objective: Intra-aortic balloon pump (IABP)-induced pulsatile perfusion has demonstrated that it can preserve organ function during cardiopulmonary bypass (CPB). We evaluated the role of IABP pulsatile perfusion on endothelial response. Methods: Forty consecutive isolated CABG undergoing preoperative IABP were randomized to receive IABP pulsatile CPB during aortic cross-clamping (group A, 20 patients) or standard linear CPB (group B, 20 patients) during cross-clamp time. Hemodynamic results were analyzed by Swan-Ganz catheter [mean arterial pressure (MAP), cardiac index (CI), indexed systemic vascular resistances (ISVR), indexed pulmonary vascular resistances (IPVR), wedge pressure (PCWP)]. Inflammatory/endothelial response was analyzed by pro-inflammatory (IL-2, IL-6, IL-8), anti-inflammatory cytokines (IL-10), and endothelial markers [vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1)]. All measurements were recorded preoperatively (T0), before aortic declamping (T1), at the end of surgery (T2), 12 h (T3) and 24 h (T4) postoperatively. ANOVA for repeated measures was used to evaluate the differences of means. Results: Hemodynamic response was comparable except for higher MAP (p = 0.01 at T1) and lower ISVR (p = 0.001 at T1, p = 0.003 at T2) in group A. No differences were found in perioperative leakage of IL-2, IL-6, and IL-8 between the two groups (within-group p = 0.0001 either in group A and group B; between-groups p = NS at 2-ANOVA). Group A showed significantly lower VEGF (between-groups p = 0.001 at 2-ANOVA, p = 0.001 at T1, T2) and MCP-1 (between-groups p = 0.001 at 2-ANOVA, p = 0.001 at T1, T2) with higher IL-10 secretion (between-groups p = 0.001 at 2-ANOVA, p = 0.01 at T1, T2, T3). Conclusions: IABP-induced pulsatile perfusion allows lower endothelial activation during CPB and higher anti-inflammatory cytokines secretion.

Key Words: Intra-aortic balloon pump • Pulsatile perfusion • Endothelial response • Cytokine • Inflammation