Cardiac interleukin-6 release and myocardial recovery after aortic crossclamping. Crystalloid versus blood cardioplegia
Liebold, A.; Langhammer, T.h.; Brünger, F.; Birnbaum, D.E.
Journal of Cardiovascular Surgery 40(5): 633-636
1999
ISSN/ISBN: 0021-9509 PMID: 10596994 Document Number: 506591
Background. Pro-inflammatory cytokines may play an important role in patient response to cardiopulmonary bypass (CPB). Since the myocardium is proposed to be a major source of cytokines, we studied the influence of the cardioplegia type on interleukin-6 release and early myocardial recovery. Methods. Experimental design: prospective, randomized study. Setting: university hospital, operative and intensive care. Patients: 20 consecutive patients (3 females) scheduled for elective coronary artery bypass grafting (CABG), mean age 62.8+-5 years, history of myocardial infarction 11/20, left ventricular ejection fraction 62.9+-15%. Interventions: patients were operated on using randomly either cold blood cardioplegia (B, n=10) or cold crystalloid cardioplegia (C, n=10). Measures: plasma levels of interleukin-6 (IL-6) were measured prior to CPB, after aortic declamping, after CPB, 1 hour, 6 hours and 12 hours postoperatively. Results. Groups were comparable with respect to demographic data, left ventricular function, number of grafts, CPB and aortic crossclamp time. Group B patients demonstrated significant lower IL-6 levels after 1 hour (210+-108 vs 578+-443 pg/ml), 6 hours (204+-91 vs 1210+-671 pg/ml) and 12 hours (174+-97 vs 971+-623 pg/ml). Post-CPB cardiac index was superior in group B (3.9+-0.3 vs 3.2+-0.3 l/min/m2, p<0.05) with similar doses of inotropes. Group B patients could earlier be weaned off respirator (10+-4 vs 13+-4 hours, p<0.05) and showed minor blood loss (635+-211 vs 918+-347 ml, p<0.05). Conclusions. Inflammatory response to CPB is associated with delayed myocardial recovery. The use of blood cardioplegia may attenuate inflammatory reactions.