Effect of cardiopulmonary bypass on cytokine network and myocardial cytokine production

Department of Surgical Research and Techniques, University of Pecs, Hungary.
Clinical Cardiology (Impact Factor: 2.59). 07/2006; 29(7):311-5. DOI: 10.1002/clc.4960290708
Source: PubMed


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.

Download full-text


Available from: Subhamay Ghosh, Oct 18, 2014
  • Source
    • "Anti-inflammatory cytokines counteract proinflammatory activation, and they may therefore protect tissues and organs during and after cardiac surgery. Recent data from patients with different inflammatory conditions suggest that the balance between pro-and anti-inflammatory cytokines is at least as important as the absolute levels of cytokines [4] [5] [6] [7] [8] [9]. The balance is often presented as the IL-6-to-IL-10 ratio. "
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Feb 2013 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
  • Source
    • "In an extremely elevated concentration proinflammatory cytokines can modulate the function of organs, while dominant anti-inflammatory ones may counteract them. The balance between pro-and anti-inflammatory cytokines may be essential for appraising the genuine effect of different cytokines [34]. In our study the ratio of pro-and anti-inflammatory cytokines was higher in survivors till day 3 following trauma, and gradually decreased thereafter, while it showed a step-by-step elevation in non-survivors later on. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Trends and the prognostic value of cytokine responses to severe burns have not been fully examined in humans. Therefore, the aim of this study was to determine the time course and prognostic value of pro- and anti-inflammatory cytokines in the immediate post-burn period. Blood samples were taken for measuring IL-1 beta, IL-6, IL-8, IL-10, IL-12p70 and TNF-alpha concentrations from patients with more than 20% burned surface area on admission and on 5 consecutive days. Development of sepsis was assessed using standard criteria twice a day. IL-12p70 remained under assay detection levels in the study period. IL-1 beta and TNF-alpha could be detected in stimulated blood samples with higher levels in survivors (n=21). IL-6 on days 4-5 and IL-8 on days 4-6 in non-stimulated plasma showed significant elevation in non-survivors (n=18) whereas in stimulated blood its levels did not differ significantly. IL-10 levels were significantly higher in non-survivors during the study period in non-stimulated, and except day 6 in stimulated blood. Using the cut-off level of 14 pg ml(-1) for IL-10 predicted ICU mortality with 85.4% sensitivity and 84.2% specificity on admission. Early anti-inflammatory excess had a bad prognosis for patients suffering from severe burns.
    Full-text · Article · Jun 2010 · Burns: journal of the International Society for Burn Injuries
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The study focuses on the impact of breathing hyperoxic (>96% oxygen) gas mixture on the myocardial metabolism and function in patients undergoing coronary artery bypass grafting.
    Full-text · Article ·
Show more