Effect of cardiopulmonary bypass on cytokine network and myocardial cytokine production.
ABSTRACT In addition to the well-investigated proinflammatory cytokine expression, there is an ever increasing interest in the field of anti-inflammatory response to cardiopulmonary bypass (CPB). Evidence suggests that myocardium serves as an important source of cytokines during reperfusion and application of CPB. The effect of coronary artery bypass graft (CABG) without CPB on myocardial cytokine production has not as yet been investigated.
Cardiopulmonary bypass can cause long-term disturbance in pro- and anti-inflammatory cytokine balance, which may impede a patient's recovery following surgery. Therefore, the effect of CPB on the balance of the pro-/anti-inflammatory cytokines network and myocardial cytokine outflow was assessed throughout a longer period after surgery.
Twenty patients were scheduled for CABG with CPB and 10 had off-pump surgery. Blood samples were taken before, during, and over the first week following surgery. Coronary sinus blood samples were collected during surgery. The ratio of pro- and anti-inflammatory cytokines was calculated and the cytokine concentration of peripheral and coronary sinus blood were compared in both groups.
Pro-/anti-inflammatory cytokine ratio decreased early after CPB followed by a delayed and marked increase. A more balanced ratio was present following off-pump surgery. Coronary sinus levels of certain cytokines exceeded the concentration of systemic blood in the course of CPB but not during off-pump operation.
Patients show pro-inflammatory predominant cytokine balance at a later stage after CPB in contrast to those without CPB. The heart produces a remarkable amount of cytokines only in the course of surgery with CPB.
- SourceAvailable from: Thomas Ryan[Show abstract] [Hide abstract]
ABSTRACT: Introduction. Severe sepsis in humans may be related to an underlying profound immune suppressive state. We investigated the link between gene expression of immune regulatory cytokines and the range of illness severity in patients with infection and severe sepsis. Methods. A prospective observational study included 54 ICU patients with severe sepsis, 53 patients with infection without organ failure, and 20 healthy controls. Gene expression in peripheral blood mononuclear cells (PBMC) was measured using real-time polymerase chain reaction. Results. Infection differed from health by decreased expression of the IL2, and IL23 and greater expression of IL10 and IL27. Severe sepsis differed from infection by having decreased IL7, IL23, IFN γ , and TNF α gene expression. An algorithm utilising mRNA copy number for TNF α , IFN γ , IL7, IL10, and IL23 accurately distinguished sepsis from severe sepsis with a receiver operator characteristic value of 0.88. Gene expression was similar with gram-positive and gram-negative infection and was similar following medical and surgical severe sepsis. Severity of organ failure was associated with serum IL6 protein levels but not with any index of cytokine gene expression in PBMCs. Conclusions. Immune regulatory cytokine gene expression in PBMC provides a robust method of modelling patients' response to infection.Mediators of Inflammation 01/2013; 2013:164246. · 2.42 Impact Factor
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ABSTRACT: Der kardiopulmonale Bypass („cardiopulmonary bypass“, CPB) ist ein Standardverfahren der Herzchirurgie. Neben den therapeutischen Perspektiven, die dieses Verfahren eröffnet, ist es selbst Ausgangspunkt für systemische und organspezifische Komplikationen. Typische Organkomplikationen sind Herzinsuffizienz, renale und pulmonale Dysfunktionen, Gerinnungsalterationen sowie neurologische und kognitive Einschränkungen. Die immunologische Reaktion auf die extrakorporale Zirkulation (EKZ) löst eine systemische Inflammation aus, die häufig die Definitionskriterien eines „systemic inflammatory response syndrome“ (SIRS) erfüllt. Die wesentlichen Ursachen hierfür sind der Kontakt des Bluts zur künstlichen Oberfläche der Herz-Lungen-Maschine (HLM), der mechanische Stress, der auf die Blutbestandteile einwirkt, und das beträchtliche operative Trauma. Eine Vielzahl an technischen Veränderungen der HLM zielt auf eine Reduktion der Inflammationsreaktion durch den CPB ab. Aus operationstechnischen Gründen kann heute bei einem Großteil des kardiochirurgischen Operationsspektrums noch nicht auf eine EKZ verzichtet werden. Es werden jedoch kontinuierlich Verfahren entwickelt, die das Ziel verfolgen, das operative Trauma und die negativen Auswirkungen des CPB zu reduzieren. Als positiv haben sich diesbezüglich verkleinerte Systeme mit biokompatiblen Oberflächen erwiesen. Alternative Verfahren wie die koronarchirurgische „Off-pump“-Chirurgie reduzieren CPB-assoziierte Organkomplikationen, werden jedoch aufgrund systemspezifischer Limitationen die konventionelle Bypasschirurgie nicht ersetzen können.Der Anaesthesist 10/2012; 61(10). · 0.74 Impact Factor
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ABSTRACT: OBJECTIVES: The inflammatory response after cardiac surgery is characterized by a profound release of pro- and anti-inflammatory cytokines. Recent data suggest that the balance between pro- and anti-inflammatory cytokines is of greater importance than the absolute levels. Retransfusion of unwashed cardiotomy suction blood contributes to the inflammatory response, but the balance between pro- and anti-inflammatory cytokines in cardiotomy suction blood and whether cell salvage before retransfusion influences the systemic balance have not been investigated previously. METHODS: Twenty-five coronary artery bypass grafting patients were randomized to either cell salvage of cardiotomy suction blood or no cell salvage before retransfusion. Plasma levels of three anti-inflammatory cytokines [interleukin (IL)-1 receptor antagonist, IL-4 and IL-10] and two proinflammatory cytokines (tumour necrosis factor-alpha and IL-6), and the IL-6-to-IL-10 ratio was measured in cardiotomy suction blood before and after cell salvage, and in the systemic circulation before, during and after surgery. RESULTS: Plasma levels of all cytokines except IL-4 and IL-10 were significantly higher in cardiotomy suction blood than in the systemic circulation. The IL-6-to-IL-10 ratio was 6-fold higher in cardiotomy suction blood than in the systemic circulation [median 10.2 (range 1.1-75) vs 1.7 (0.2-24), P < 0.001]. Cell salvage reduced plasma levels of cytokines in cardiotomy suction blood and improved the systemic IL-6-to-IL-10 ratio 24 h after surgery [median 5.2 (3.6-17) vs 12.4 (4.9-31)] compared with no cell salvage (P = 0.032). CONCLUSIONS: The balance of pro- and anti-inflammatory cytokines in cardiotomy suction blood is unfavourable. Cell salvage reduces the absolute levels of both pro- and anti-inflammatory cytokines in cardiotomy suction blood and improves the balance in the systemic circulation after surgery.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2013; · 2.40 Impact Factor
Effect of Cardiopulmonary Bypass on Cytokine Network and Myocardial
B. GASZ, M.D., L. LENARD, M.D., PH.D.,* B. RACZ, L. BENKO, M.D., B. BORSICZKY, M.D., PH.D., B. CSEREPES, M.D., J. GAL, M.D., PH.D.,
G. JANCSO, M.D., PH.D., J. LANTOS, M.D., PH.D., S. GHOSH, M.D.,‡ S. SZABADOS, M.D., PH.D.,* L. PAPP. M.D., PH.D.,*
N. ALOTTI, M.D., PH.D.,† E. ROTH, M.D., PH.D., D.SC.
Department of Surgical Research and Techniques, and *Heart Institute, University of Pecs, Pecs; †Department of Cardiac Surgery,
Zala County Hospital, Zalaegerszeg; ‡Department of Anaesthesia and Intensive Care, Baranya County Hospital, Pecs, Hungary
Background:In addition to the well-investigated proinflam-
matory cytokine expression, there is an ever increasing interest
in the field of anti-inflammatory response to cardiopulmonary
bypass (CPB). Evidence suggests that myocardium serves as
an important source of cytokines during reperfusion and appli-
cation of CPB. The effect of coronary artery bypass graft
(CABG) without CPB on myocardial cytokine production has
not as yet been investigated.
Hypothesis:Cardiopulmonary bypass can cause long-term
disturbance in pro- and anti-inflammatory cytokine balance,
which may impede a patient’s recovery following surgery.
Therefore, the effect of CPB on the balance of the pro-/anti-
inflammatory cytokines network and myocardial cytokine
outflow was assessed throughout a longer period after surgery.
Methods:Twenty patients were scheduled for CABG with
CPB and 10 had off-pump surgery. Blood samples were taken
before, during, and over the first week following surgery.
Coronary sinus blood samples were collected during surgery.
The ratio of pro- and anti-inflammatory cytokines was calcu-
lated and the cytokine concentration of peripheral and coro-
nary sinus blood were compared in both groups.
Results: Pro-/anti-inflammatory cytokine ratio decreased
early after CPB followed by a delayed and marked increase. A
more balanced ratio was present following off-pump surgery.
Coronary sinus levels of certain cytokines exceeded the con-
centration of systemic blood in the course of CPB but not dur-
ing off-pump operation.
Conclusion:Patients show pro-inflammatory predominant
cytokine balance at a later stage after CPB in contrast to those
without CPB. The heart produces a remarkable amount of cy-
tokines only in the course of surgery with CPB.
Key words: coronary artery bypass graft, cardiopulmonary
bypass, inflammatory response, myocardial injury, cytokines
Recent researches have shown that the activation of acute
immune reactions resulting from operative trauma, blood
exposure to artificial surface, damage of barrier of intestinal
mucosa, abnormal blood gas interfaces, and reperfusion in-
jury after global ischemia of the heart is one of the most for-
midable aspects of the pathophysiology of cardiopulmonary
The release of different cytokines regarded as mediators that
orchestrate the inflammatory processes, cellular activation, and
leukocyte migration, is of central importance. Proinflamma-
tory cytokines in extremely elevated concentrations can modu-
late the function of organs.2–5Dominant anti-inflammatory ef-
fects, however, can blunt adequate immune response, impair-
ing defensive mechanisms and healing processes. The balance
between pro- and anti-inflammatory cytokines is essential for
appraising the genuine effect of different cytokines and the
characteristics of the cytokine network. Temporal change of
the balance between pro- and anti-inflammatory cytokines has
been less investigated.
Clin. Cardiol. 29, 311–315 (2006)
This work was supported by Hungarian Scientific Research Fund,
OTKA T038035 and OTKA T34810.
Address for reprints:
Dr. Balazs Gasz
Department of Surgical Research and Techniques
University of Pecs
H-7624, Kodaly Zoltan u. 20
Received: December 3, 2005
Accepted with revision: April 4, 2006
Clin. Cardiol. Vol. 29, July 2006
Studies have shown that coronary artery bypass graft
(CABG) surgery performed without CPB, known as off-pump
(OP) surgery, helps to avoid unwanted effects such as overac-
tivation of the inflammatory response.4
Evidence suggests that the myocardium is capable of syn-
thesizing biologically active cytokines.6The effect of OP sur-
gery on myocardial cytokine production has not as yet been
investigated in detail. Therefore, this study investigates the as-
sociation between CPB or OP surgery and considerable cy-
tokine production by the heart.
Main Outcome Measures
The main outcome measures in patients who underwent
surgery with or without CPB were the pro-/anti-inflammatory
cytokine ratio up to the end of first postoperative week, the al-
teration in interleukin (IL)-12 levels during and after both
types of surgery, and the myocardial outflow of cytokines in
the course of surgery with or without CPB.
Thirty patients undergoing elective CABG were selected
for the study. The subjects were randomly sorted into two
groups: Group 1 consisted of 20 patients who received con-
ventional CABG using CPB and Group 2 of 10 patients who
underwent OP surgery. There were no significant differences
in the preoperative data of patients (age of patients in Group 1:
62.64 ±8.76 years and in Group 2: 63.36 ±5.78 years; three
women in Group 1 and two in Group 2; Euro score 2.78 ±1.56
in Group 1 and 2.6 ±1.51 in Group 2). Patients with immuno-
logic disease, recent myocardial infarction (<3 months), pre-
vious stroke, or those undergoing acute or repeat surgery, and
those who developed infection, coagulopathy, tumor, acute or
chronic renal failure, and respiratory impairment were exclud-
ed from the study.
The protocol of the study was approved by the Ethics Com-
mittee, and oral and written informed consent was obtained
from all patients. Investigations were performed in accordance
with the Declaration of Helsinki.
Anesthesia and Surgical Technique
Both groups of patients received 10 mg midazolam as pre-
medication. Anesthesia was induced with midazolam 0.1 mg.
kg?1, fentanyl 2µg. kg?1, and propofol 2 mg. kg?1. After ade-
quate neuromuscular block with pipecuronium 0.1 mg kg?1,
the airway was secured with an endotracheal tube. In patients
undergoing CPB, total intravenous anesthesia was maintained
with continuous infusion of propofol. After administration of
heparin 300 IU kg?1, a hollow fiber oxygenator and a roller
pump were used to achieve moderate hypothermic CPB.
Myocardial preservation was performed with cold crystalloid
cardiolplegia and topical cooling. Heparin was neutralized
with protamine sulphate after CPB. In Group 2, anesthesia
was maintained with sevoflurane 0.5–1% and nitrous oxide
60% in oxygen. Using Octopus (Medtronic, Inc., Minneap-
olis, Minn., USA), cardiac stabilizer coronary arteries were
occluded for <20 min.
In Group 1, blood samples from peripheral vein were taken
right after the induction of anesthesia, then 5 min after the ces-
sation of aorta cross clamping, and on postoperative Days 1, 2,
3, and 7. In Group 2, blood samples were collected after the in-
duction of anesthesia, 5 min after completion of the last graft,
and on postoperative Days 1, 2, 3, and 7.
Further blood samples were taken from the coronary sinus
(CS) using a catheter in both groups: 5 min after declamping
of the aorta in Group 1, and 5 min after the completion of the
last graft in Group 2.
All samples were collected in sterile vacuum tubes contain-
ing sodium heparin.
Measurement of Cytokines
Blood samples from the peripheral vein were first incubat-
ed at 37ºC for 4 h and then stimulated with phorbol 12-myris-
tate13-acetate (PMA, 111 ng ml-1). After this period of stimu-
lation, tubes were centrifuged at 3,000 g for 10 min; then, the
supernatant was separated into vials, frozen immediately to
?75ºC, and stored at that temperature until the day measure-
ments were taken (within 2 months). The plasma concentra-
tions of stimulated cytokines were determined by using the
Becton Dickinson cytometric bead array (CBA Human
Inflammatory Kit, BD Biosciences, Pharmingen, Boston,
Mass., USA) and by following the instruction manual. This
newly developed method allows for reliable simultaneous
measurement of six human cytokine levels: tumor necrosis
factor (TNF) ?and IL –1?, 6, 8, 10, 12p70 (TNF, IL-1, IL-6,
IL-8, IL-10, IL-12) from small sample volumes.
Besides the monitoring of the absolute concentration of giv-
en cytokines, the pro-/anti-inflammatory cytokine balance
was calculated in all samples by dividing the plasma concen-
tration of different proinflammatory cytokines with the con-
centration of interleukin-10.
During CS blood sampling (in the fifth min of reperfusion),
other peripheral blood samples were collected to compare the
plasma concentration of cytokines between CS and peripheral
vein samples. The PMA stimulation releases cytokines pro-
duced by white blood cells. To obtain the cytokines secreted
only by the myocardium, PMA stimulation was neglected
both in CS and peripheral vein samples. These samples were
measured as described above. Cytokine levels of CS blood
were not obtained before CPB and ischemia. It is known that
without any stimulation or in chronic condition, the level of cy-
tokines CS and systemic, peripheral concentration of cy-
tokines are the same.
The concentration of unstimulated peripheral vein samples
was considered to be 100% in each sample. The cytokine lev-
els of CS samples were compared with their corresponding pe-
ripheral vein levels, expressing the values in percentage.
B. Gasz et al.: Cytokine network following cardiopulmonary bypass
The data are presented in the Figures as mean ±standard de-
The data between the two groups were compared with the
unpaired Student’s t-test. In a given group, comparisons of
control data were made using paired Student’s t-test. Differ-
ences were considered significant at p values <0.05.
There was no hospital mortality pulmonary insufficiency
or neurologic complication in either Group 1 or in Group 2.
The duration of aortic cross-clamping in Group 1 was 64.13 ±
Assessment of Cytokine Balance
The balance between inflammatory and anti-inflammatory
forces was determined by calculating the proinflammatory cy-
tokine/IL-10 ratio. The ratio was similar in the CPB and OP
groups. The TNF/IL-10, IL-6/IL-10, and IL-8/IL-10 ratio is
shown in Figure 1A, B, and C. In Group 1, an early drop was
observed during surgery, and afterward the ratio increased
extremely throughout the observation period. During surgery
in the fifth min of reperfusion, the decrease in TNF/IL-10,
IL-1/IL-10, IL-6/IL-10, and IL-8/IL-10 ratios was significant
when compared with the corresponding preoperative ratios. In
Group 2, the ratio of given proinflammatory cytokine and
IL-10 tended to decrease, reaching its minimum value on post-
operative Days 1 or 2; thereafter, it normalized gradually.
Statistical analysis revealed significant differences between
Groups 1 and 2, first in the TNF/IL-10 ratio on postoperative
Days 1, 2, 3, and 7 (Fig. 1A), then in the IL-6/IL-10 ratio on
postoperative Days 2 and 3 (Fig. 1B), in the IL-8/IL-10 ratio in
the 5th minute of reperfusion, and on postoperative Days 1 and
2 (Fig. 1C).
Concentration of Cytokines from Samples of
In Group 1, all observed cytokines from CS exceeded the
concentrations of peripheral vein samples (Fig. 2). The differ-
ence between sinus and peripheral vein samples proved to be
significant for the IL-1, IL-6, IL-8, and TNF levels.
During OP surgery, the cytokine concentrations of the CS
and peripheral vein were roughly equivalent (Fig. 2). It is in-
teresting that the greatest difference was seen in IL-10, al-
though it was not statistically significant.
This study shows that CPB caused a prolonged proinflam-
matory predominant response. The pro-/anti-inflammatory ra-
tio could be balanced by minimal invasive OP technique. The
present investigations also demonstrate that the application of
CPB and not the OP technique is associated with cytokine pro-
duction of the myocardium.
POD2 POD3 POD7
POD2 POD3 POD7
POD2 POD3 POD7
FIG. 1 Tumor necrosis factor (TNF) ?and interleukin (IL)-10 (A),
interleukin-6 and interleukin-10 (B), interleukin-8 and interleukin-
10 (C) ratio over the time in patients undergoing coronary artery by-
pass grafting with cardiopulmonary bypass (Group 1) or off-pump
technique (Group 2). Data are presented as mean ±standard devia-
tion. * = p<0.05 compared with preoperative values (control); ** =
p<0.03 related to preoperative values (control); # = p<0.05 com-
pared with other groups at the same time point; ## = intergroup dif-
ference p<0.03. Control-before surgery, IL-interleukin, POD 1, 2,
3, 7-on the postoperative Day 1, 2, 3, and 7. Rep5 = time point 5 min
after the beginning of reperfusion, TNF-tumor necrosis factor ?.
–I– = Group 1, –M M–= Group 2.
Clin. Cardiol. Vol. 29, July 2006
In this paper, a completely novel method is demonstrated
for measuring six cytokines simultaneously from a single
sample with cytometry using the cytometric bead array (CBA)
technique.7, 8This method appears to be an easier, more reli-
able technique for measuring cytokines compared with con-
ventional enzyme-linked immunosobent assay (ELISA), con-
sidering the fact that 300 microparticles are measured for each
cytokine, all of them containing approximately the same num-
ber of antibodies as are present in one well of an original
ELISA kit. Moreover, the CBA technique is highly suitable for
assessing the ratio between different cytokines because it can
determine six cytokines from the same sample, thereby elimi-
nating certain errors.8
Two interesting but rare findings of the present study are
the early but significant decrease in TNF and IL-1 concentra-
tions and the late elevation of proinflammatory cytokines.
The first can be explained by the extravasation and adherence
of active leukocytes to the site of reperfusion and extracorpo-
real circuit;1, 3the latter aspect is the second wave of proin-
flammatory response, which refers to the potential contribu-
tion of mediators, further activating the proinflammatory
forces.9Evidence is growing to suggest the role such a mark-
er plays in pathomechanism of CPB.10
The investigation of IL-12 is of utmost importance as it is
known to control type-1 T helper cell (TH1)-mediated im-
mune response. Some articles suggest that IL-12 drops early
after the patient is weaned from CPB.11, 12According to the
findings of this study, the TH1/TH2 response changes in two
phases after CPB: first, the TH2-mediated response is stronger
subsequently, and second, after postoperative Day 1, the TH1-
mediated response tends to be upregulated. Likewise, in the
course of OP surgery, it is associated with a more moderate
shift in TH1/TH2 response determined by the cytokine pattern.
The absolute concentration of cytokines is considered to be
less important than their relative balance, which may better
reflect the net effect of cytokine response.14The novelty of
this study lies in the acknowledgment that the increased and
continuously elevating force of proinflammatory response is
balanced only during the early postoperative period by IL-10
in patients undergoing CABG with CPB. The results of this
study concerning the anti-inflammatory predominant re-
sponse to CPB up to postoperative Day 1 agree with the out-
comes of other studies.2, 13Moreover, Hövers-Gürich et al.re-
ported similar alterations regarding the later events observing
infant patients, specifically the elevation in proinflammatory
cytokines without the counterbalance of IL-10.13In addition,
a lesser alteration in the balance of pro- and anti-inflammato-
ry responses can be observed after OP operation with domi-
nating anti-inflammatory forces. Franke et al.found similar
results regarding proinflammatory cytokine levels.14
These results may have therapeutic consequences. Steroid
administration is known to reduce the generation of proinflam-
matory cytokines with the exaggeration of IL-10 and anti- in-
flammatory cytokine response, thereby reducing the ratio of
pro- and anti-inflammatory cytokines.15In most studies exam-
ining the efficacy of steroid treatment in patients receiving
CPB, steroids were administered before or during surgery.16
Although the majority of these investigations confirmed the
beneficial effect of preoperative steroid treatment, others sug-
gest an adverse effect of preoperative steroid treatment.17Our
findings suggest the eventual necessity of longer-term admin-
istration of corticosteroids. With respect to the aspect of cy-
tokine balance, steroid administration or anti-inflammatory
treatment should be required only from postoperative Day 2 up
to the end of the first week. Cytokine response after OP sur-
gery, however, does not require any anti-inflammatory treat-
ment because it is balanced with anti-inflammatory batteries.
The inspection of the increased myocardial outflow of dif-
ferent cytokines during CPB is another interesting finding of
the present study. In the OP group, no obvious differences
could be observed between cytokines of peripheral-venous
and CS blood. To our knowledge, this is the first study com-
paring the myocardial production of cytokines during use of
the CPB and OP techniques. Despite cardioprotection with
cardioplegia and cooling, the heart is exposed to relatively
long-term and global ischemia as a result of cross clamping of
the aorta, which may provoke myocardial cytokine production
due to large amounts of free radicals resulting from the activa-
tion of nuclear factor-kappa B (NF-KB).18, 19In the course of
OP surgery, however, myocardial and cardiac endothelial cells
respond to brief and partial ischemic periods. Brief periods of
coronary ligatures during ischemic preconditioning may result
in protection via protein production with protective effects and
without expression of cytokines.
Numerous papers have recorded significantly elevated
IL-6, IL-8, and TNF concentrations of CS compared with ar-
terial blood without deviance of IL-10.6, 20Since cytokine lev-
els are elevated in the CS, the local concentration of these cy-
tokines may increase more noticeably during and after CPB,
causing augmented reactions and injurious effects in the
TNFIL-1IL-6IL-8 IL-12 IL-10
FIG. 2 Cytokine levels of coronary sinus blood during coronary
artery bypass graft with cardiopulmonary bypass (Group 1) and with
off-pump technique (Group 2). Dark bars show Group 1 and light
bars represent Group 2. Concentrations are presented as percent of
peripheral venous blood level of given cytokine at the same time.
Data are shown as mean ±standard deviation. * = p<0.05 compared
with the concentration of peripheral venous blood. I= Group 1, I I=
Group 2. IL = interleukin, TNF = tumor necrosis factor ?.
B. Gasz et al.: Cytokine network following cardiopulmonary bypass
The relatively small number of patients investigated may be
a limitation of the present study. A larger number of patients
would allow for the examination of cytokine balance and my-
ocardial cytokine production in high-risk patients or in patients
with prolonged recovery, postoperative myocardial dysfunc-
tion, respiratory failure, and so forth. The fact that the anes-
thetic technique was not entirely the same in the groups may
also be a limitation. Using different techniques made it diffi-
cult to standardize anesthesia and intraoperative treatment.
Studies investigating the effect of anesthesia on cytokine pro-
duction state indicate a change in selected cytokines after anes-
thesia with different agents. Most of these studies applied <24
h observation periods and examined cytokines that changed
just after wound closure as a direct effect of chosen anesthetic
The present study has attempted to give a comprehensive
view of the alteration of the cytokine network during and after
CABG with and without CPB using a novel method, the CBA
technique. The investigations highlight the usefulness of this
technique, also in clinical practice, for obtaining pro- and anti-
inflammatory response because it is reliable and simple.
Hence, in the course of CPB, the elevation of proinflammato-
ry cytokine is highly counterbalanced by the systematic re-
lease of IL-10 during and in the early period following the
surgery. Consequently, after postoperative Day 1, a signifi-
cantly elevated pro-/anti-inflammatory cytokine ratio was
measured. In contrast, OP surgery is associated with a rather
balanced relation of pro- and anti-inflammatory responses.
The concentration of IL-12 was also higher following CPB.
This study revealed the myocardial outflow of certain proin-
flammatory cytokines during CPB, as manifested by a higher
sinus level of IL-1, IL-6, IL-8, and TNF, while it was undetect-
ed in the course of OP surgery. These results may reflect the
different cellular effects of the two procedures and aim to im-
prove our understanding of the impact of CPB on patients.
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