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Ann Thorac Surg 2002;73:1905-1909
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Lactic acidosis after cardiac surgery is associated with polymorphisms in tumor necrosis factor and interleukin 10 genes

^a Departments of department of Anaesthesia, St James’s Hospital, Dublin, Ireland
^b Department of Hereditary Coagulation Disorders, St James’s Hospital, Dublin, Ireland
^c Department of Cardiothoracic Surgery, St. James’s Hospital, Dublin, Ireland

Accepted for publication February 17, 2002.

* Address reprint requests to Dr Ryan, Department of Anaesthesia, St. James’s Hospital, James St, Dublin 8, Ireland
e-mail: ryants{at}iol.ie

Background. Lactic acidosis after cardiac surgery is a manifestation of excess cytokine production. Cytokine-related genetic polymorphisms account for variability in cytokine response and may predispose to the development of lactic acidosis after cardiac surgery.

Methods. Routine postoperative cardiac surgery patients were studied. Lactic acid levels were greater than 4 mmol/L in study patients and less than 4 mmol/L in controls. Polymerase chain reaction-based techniques were used to examine carriage of tumor necrosis factor ß (TNF-ß), TNF G-308A, and interleukin 10 (IL-10) G-1082A alleles.

Results. Demographic characteristics and details of surgery were similar for 30 control and 21 study patients. Lactic acid levels after intensive care admission changed over time and were related to both TNF-ß and IL-10 G-1082A polymorphisms. All 4 study patients homozygous for TNF-ß1 and carrying an IL-10–1082A allele developed lactic acidosis (p = 0.02). There was no relation between the rate of epinephrine infusion or duration of cardiopulmonary bypass and lactic acid levels.

Conclusions. Genetic factors have a role in the development of lactic acidosis after cardiac surgery.

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Invited commentary

A. Leins and J. Cremer
Ann. Thorac. Surg. 2002 73: 1910-1911. [Extract] [Full Text] [PDF]

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