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Ann Thorac Surg 1999;68:52-56
© 1999 The Society of Thoracic Surgeons
a Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic of China
b Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic of China
Address reprint requests to Dr S. Wan, Division of Cardiothoracic Surgery, Dept of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
e-mail: swan{at}cuhk.edu.hk
Presented at the 19th Annual San Diego Cardiothoracic Surgery Symposium "Pathophysiology and Techniques of Cardiopulmonary Bypass," San Diego, CA, Feb 18–20, 1999.
Background. Proinflammatory cytokines play a key role in the inflammatory cascade after cardiopulmonary bypass and may induce cardiac dysfunction. We compared the production of cytokines and the degree of postoperative myocardial injury in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting through median sternotomy with or without cardiopulmonary bypass.
Methods. Forty-four consecutive patients were studied. Patients were selected for off-pump coronary artery bypass grafting whenever complete revascularization was technically feasible. There were no differences between the two groups with respect to age, sex, symptoms, or functional class. Plasma levels of tumor necrosis factor-
, interleukin (IL)-6, IL-8, and IL-10 were measured before the operation, at the end of the procedure, and 2, 4, 8, 24, and 48 hours thereafter. Levels of the MB isoenzyme of creatine kinase and cardiac troponin-I were also measured after the operation.
Results. The number of grafts was 2 ± 0.7 in the off-pump group (n = 18) and 3 ± 0.8 in the cardiopulmonary bypass group (n = 26). There were no deaths or major complications in either group. Levels of tumor necrosis factor- were low in both groups. No significant intergroup differences were noted regarding serial IL-6 measurements. However, IL-8 and IL-10 levels after the operation were lower in the off-pump group (IL-8, 4 ± 1 versus 38 ± 12 pg/mL, p < 0.01; IL-10, 5 ± 2 versus 191 ± 33 pg/mL, p < 0.001). Whereas postoperative creatine kinase-MB values were similar in the two groups, cardiac troponin-I levels were significantly lower in the off-pump group (8 hours, p < 0.005; 24 hours, p < 0.02, respectively). Moreover, cardiac troponin-I values 24 hours after operation correlated strongly with IL-8 levels (r = 0.61, p < 0.005), indicating that the degree of myocardial injury may be related to IL-8 production.
Conclusions. Compared with conventional coronary artery bypass grafting, coronary revascularization without cardiopulmonary bypass is associated with reduced cytokine responses and less myocardial injury.
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Ann. Thorac. Surg. 1999 68: 56-57.
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A. P.C. Yim, S. Wan, T. W. Lee, and A. A. Arifi VATS lobectomy reduces cytokine responses compared with conventional surgery Ann. Thorac. Surg., July 1, 2000; 70(1): 243 - 247. [Abstract] [Full Text] [PDF]
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M. Czerny, H. Baumer, J. Kilo, A. Lassnigg, A. Hamwi, T. Vukovich, E. Wolner, and M. Grimm Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass Eur. J. Cardiothorac. Surg., June 1, 2000; 17(6): 737 - 742. [Abstract] [Full Text] [PDF]
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V. R. Kshettry, T. F. Flavin, R. W. Emery, D. M. Nicoloff, K. V. Arom, and R. J. Petersen Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity? Ann. Thorac. Surg., June 1, 2000; 69(6): 1725 - 1730. [Abstract] [Full Text] [PDF]
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S. C. Stamou, A. J. Pfister, G. Dangas, M. K.C. Dullum, S. W. Boyce, A. S. Bafi, J. M. Garcia, and P. J. Corso Beating heart versus conventional single-vessel reoperative coronary artery bypass Ann. Thorac. Surg., May 1, 2000; 69(5): 1383 - 1387. [Abstract] [Full Text] [PDF]
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S. Wan, J.-L. LeClerc, M. Antoine, J.-M. DeSmet, A. P.C. Yim, and J.-L. Vincent Heparin-coated circuits reduce myocardial injury in heart or heart-lung transplantation: a prospective, randomized study Ann. Thorac. Surg., October 1, 1999; 68(4): 1230 - 1235. [Abstract] [Full Text] [PDF]
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S. Wan and A. P.C. Yim Cytokines in myocardial injury: impact on cardiac surgical approach Eur. J. Cardiothorac. Surg., September 1, 1999; 16(suppl_1): S107 - S111. [Abstract] [Full Text] [PDF]
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