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Ann Thorac Surg 1996;61:1714-1720
© 1996 The Society of Thoracic Surgeons
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
Accepted for publication January 6, 1996.
Background. A systemic inflammatory response after open heart operation may be responsible for hyperdynamic circulatory instability and organ dysfunction. To what extent mediator release is involved needs to be clarified.
Methods. Ten patients with postoperative hyperdynamic circulatory dysregulation (group I) requiring application of 
-constrictors and 10 patients with routine cardiac procedures and stable postoperative hemodynamic indices (group II) were analyzed for mediator release and metabolic and hemodynamic changes until the third postoperative day.
Results. Group I patients showed a significantly increased cardiac index and decreased systemic vascular resistance after bypass (cardiac index, group I: 5.2 ± 1.2 L•min-1•m-2, group II: 2.5 ± 1.6 L•min-1•m-2; systemic vascular resistance, group I: 495 ± 204 dyne • s • cm-5, group II: 1,356 ± 466 dyne•s•cm-5) and at 3 hours (cardiac index, group I: 4.4 ± 0.8 L•min-1•m-2, group II: 2.9 ± 0.6 L•min-1•m-2; systemic vascular resistance, group I: 567 ± 211 dyne•s•cm-5, group II: 1,053 ± 273 dyne•s•cm-5). Significantly higher serum levels of interleukin-6 were assessed in group I (post-bypass, group I: 6,812 ± 9,293 pg/mL, group II: 295 ± 303 pg/mL; 3 hours, group I: 3,474 ± 5,594 pg/mL, group II: 286 ± 296 pg/mL). Concentrations of elastase, tumor necrosis factor, soluble tumor necrosis factor receptor, and interleukin-8 were elevated in group I (not significant). Early postoperative levels of soluble E-selectin and soluble intercellular adhesion molecule were also higher in group I (not significant). Continuously increased levels of endotoxin could be detected in only 3 of 10 patients in group I. Severe lactic acidosis (
5 mmol/L) occurred in group I only.
Conclusions. Postoperative hyperdynamic instability after open heart operations appears to be associated with a certain pattern of mediator release. In particular, interleukin-6 appears to be involved in circulatory dysregulation and metabolic derangement.
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J.-P. Yared, N. J. Starr, F. K. Torres, C. A. Bashour, G. Bourdakos, M. Piedmonte, J. A. Michener, J. A. Davis, and T. E. Rosenberger Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery Ann. Thorac. Surg., May 1, 2000; 69(5): 1420 - 1424. [Abstract] [Full Text] [PDF]
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R. A. Bronicki, C. L. Backer, H. P. Baden, C. Mavroudis, S. E. Crawford, and T. P. Green Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children Ann. Thorac. Surg., May 1, 2000; 69(5): 1490 - 1495. [Abstract] [Full Text] [PDF]
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M. Bog'a, F. Islamog'lu, I. Badak, M. Cikirikciog'lu, T. Bakalim, T. Yag'di, S. Buket, and A. Hamulu The effects of modified hemofiltration on inflammatory mediators and cardiac performance in coronary artery bypass grafting Perfusion, March 1, 2000; 15(2): 143 - 150. [Abstract] [PDF]
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T Wittwer, J Cremer, P Boonstra, J Grandjean, M Mariani, A Mugge, H Drexler, P den Heijer, E-R v Leitner, A Hepp, et al. Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study Heart, January 1, 2000; 83(1): 58 - 63. [Abstract] [Full Text] [PDF]
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M. Struber, J. T. Cremer, B. Gohrbandt, C. Hagl, M. Jankowski, B. Volker, H. Ruckoldt, M. Martin, and A. Haverich Human cytokine responses to coronary artery bypass grafting with and without cardiopulmonary bypass Ann. Thorac. Surg., October 1, 1999; 68(4): 1330 - 1335. [Abstract] [Full Text] [PDF]
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J. C. Kovacich, E. M. Boyle Jr, E. N. Morgan, T. G. Canty Jr, A. L. Farr, M. T. Caps, N. Frank, T. H. Pohlman, and E. D. Verrier INHIBITION OF THE TRANSCRIPTIONAL ACTIVATOR PROTEIN NUCLEAR FACTOR {kappa}BPREVENTS HEMODYNAMIC INSTABILITY ASSOCIATED WITH THE WHOLE-BODY INFLAMMATORYRESPONSE SYNDROME J. Thorac. Cardiovasc. Surg., July 1, 1999; 118(1): 154 - 162. [Abstract] [Full Text] [PDF]
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F. J. Baumgartner, A. Gheissari, E. R. Capouya, G. P. Panagiotides, A. Katouzian, and T. Yokoyama Technical aspects of total revascularization in off-pump coronary bypass via sternotomy approach Ann. Thorac. Surg., June 1, 1999; 67(6): 1653 - 1658. [Abstract] [Full Text] [PDF]
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U. Boeken, P. Feindt, N. Zimmermann, G. Kalweit, T. Petzold, and E. Gams Increased preoperative C-reactive protein (CRP)-values without signs of an infection and complicated course after cardiopulmonary bypass (CPB) - operations Eur. J. Cardiothorac. Surg., May 1, 1999; 13(5): 541 - 545. [Abstract] [Full Text] [PDF]
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A. Liebold, C. Keyl, and D. E. Birnbaum The heart produces but the lungs consume proinflammatory cytokines following cardiopulmonary bypass Eur. J. Cardiothorac. Surg., March 1, 1999; 15(3): 340 - 345. [Abstract] [Full Text] [PDF]
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S. T Baksaas, H. I Flom-Halvorsen, E. Ovrum, V. Videm, T. E. Mollnes, F. Brosstad, and J. L Svennevig Leucocyte filtration during cardiopulmonary reperfusion in coronary artery bypass surgery Perfusion, March 1, 1999; 14(2): 107 - 117. [Abstract] [PDF]
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S T Baksaas, V Videm, T E Mollnes, S Tollofsrud, G Hetland, T Pedersen, and J L Svennevig Leucocyte filtration during cardiopulmonary bypass hardly changed leucocyte counts and did not influence myeloperoxidase, complement, cytokines or platelets Perfusion, December 1, 1998; 13(6): 429 - 436. [Abstract] [PDF]
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G. Asimakopoulos and K. M. Taylor Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules Ann. Thorac. Surg., December 1, 1998; 66(6): 2135 - 2144. [Abstract] [Full Text] [PDF]
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J. Bonatti, R. Ladurner, H. Antretter, C. Hormann, G. Friedrich, N. Moes, V. Muhlberger, and O. Dapunt Single coronary artery bypass grafting - a comparison between minimally invasive 'off pump' techniques and conventional procedures Eur. J. Cardiothorac. Surg., October 1, 1998; 14(suppl_1): S7 - S12. [Abstract] [Full Text] [PDF]
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W. Wang, H. M. Huang, De Ming Zhu, H. Chen, Z. K. Su, and W. X. Ding Modified ultrafiltration in paediatric cardiopulmonary bypass Perfusion, September 1, 1998; 13(5): 304 - 310. [Abstract] [PDF]
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L. Lindberg, A-K. Olsson, K. Anderson, and P. Jogi SERUM S-100 PROTEIN LEVELS AFTER PEDIATRIC CARDIAC OPERATIONS: A POSSIBLE NEW MARKER FOR POSTPERFUSION CEREBRAL INJURY J. Thorac. Cardiovasc. Surg., August 1, 1998; 116(2): 281 - 285. [Abstract] [Full Text] [PDF]
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R. D. Mainwaring, J. J. Lamberti, and T. E. Hugli Complement Activation and Cytokine Generation After Modified Fontan Procedure Ann. Thorac. Surg., June 1, 1998; 65(6): 1715 - 1720. [Abstract] [Full Text] [PDF]
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P. R. B. Evora, P. J. F. Ribeiro, J. C. S. de Andrade, and K. M. Taylor Methylene Blue Administration in SIRS After Cardiac Operations Ann. Thorac. Surg., April 1, 1997; 63(4): 1212 - 1213. [Full Text]
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K. M. Taylor SIRS-The Systemic Inflammatory Response Syndrome After Cardiac Operations Ann. Thorac. Surg., June 1, 1996; 61(6): 1607 - 1608. [Full Text]
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B. Dybdahl, A. Wahba, E. Lien, T. H. Flo, A. Waage, N. Qureshi, O. F.M. Sellevold, T. Espevik, and A. Sundan Inflammatory Response After Open Heart Surgery: Release of Heat-Shock Protein 70 and Signaling Through Toll-Like Receptor-4 Circulation, February 12, 2002; 105(6): 685 - 690. [Abstract] [Full Text] [PDF]
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