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J Thorac Cardiovasc Surg 2005;129:760-766
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Surgical trauma affects the proinflammatory status after cardiac surgery to a higher degree than cardiopulmonary bypass

Roland Prondzinsky, MDa,*, Axel Knüpfer, MDa, Harald Loppnow, PhDa, Frank Redling, MDb, Dirk W. Lehmann, MDc, Ina Stabenow, MDa, Rochus Witthaut, MDa, Susanne Unverzagt, PhDd, Joachim Radke, MDc, Hans-Reinhard Zerkowski, MDb, Karl Werdan, MDa

a Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
b Department of Cardiothoracic Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
c Department of Anesthesiology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
d Operative Intensive Care Medicine und Coordination Centre for Clinical Trials, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

Received for publication December 1, 2003; revisions received June 7, 2004; accepted for publication July 6, 2004.

* Address for reprints: Roland Prondzinsky, MD, Martin-Luther-University Halle-Wittenberg, Department of Internal Medicine III, Ernst-Grube-Str 40, D-06097 Halle (Saale), Germany (E-mail: roland.prondzinsky{at}medizin.uni-halle.de).

OBJECTIVES: Cytokines contribute to the development of the systemic inflammatory response syndrome or multiple-organ failure frequently observed after cardiopulmonary bypass—supported cardiac surgery. To quantify the contribution of bypass-induced versus trauma-induced inflammatory response after coronary artery bypass grafting, we examined plasma cytokine levels in 120 patients with coronary artery disease who were treated with or without cardiopulmonary bypass—assisted procedures.

METHODS: Patients were treated in accordance with one of the following protocols: (1) elective percutaneous coronary intervention without cardiopulmonary bypass (n = 69), (2) cardiopulmonary bypass—supported percutaneous coronary intervention (cardiopulmonary bypass—percutaneous coronary intervention; n = 10), and (3) cardiopulmonary bypass—supported coronary artery bypass grafting (cardiopulmonary bypass—coronary artery bypass grafting; n = 41). Cytokine levels (picograms/milliliter) were measured by enzyme-linked immunosorbent assay from plasma samples obtained at various time points.

RESULTS: Interleukin-6 was measured in blood samples from all 3 patient populations. The maximum interleukin-6 level was 13.6 ± 22.3 pg/mL in the percutaneous coronary intervention group, 170.4 ± 165.4 pg/mL in the cardiopulmonary bypass-percutaneous coronary intervention group, and 640.3 ± 285.7 pg/mL in the cardiopulmonary bypass-coronary artery bypass grafting group. Interleukin-6 levels were significantly different, and the 95% confidence intervals did not overlap. In the cardiopulmonary bypass-percutaneous coronary intervention group, bypass duration correlated well with interleukin-6 production (r = 0.915; P < .001), whereas these parameters did not correlate in patients who underwent cardiopulmonary bypass-coronary artery bypass grafting (r = 0.307; P = .054).

CONCLUSIONS: These findings support the suggestion that surgical trauma and cardiopulmonary bypass contribute to the inflammatory response after cardiac surgery, although trauma may contribute to a higher degree.




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