The Changes And Effects Of The Plasma Levels Of Tumor Necrosis Factor After Coronary Artery Bypass Surgery With Cardiopulmonary Bypass.
Department of Cardiovascular Surgery; Izmir Sifa Hospital; Istanbul.
Abacilar F; Dogan OF; Duman U; Ucar I; Demircin M; Ersoy U; Dogan R; Boke E.
Department of Cardiovascular Surgery; Izmir Sifa Hospital; Istanbul.
BACKGROUND: Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system; leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins; or by surgical trauma. Proinflammatory cytokines; such as tumor necrosis factor (TNF)-alpha; interleukin (IL)-6; and IL-8; play an important role in the inflammatory processes after CPB and may induce cardiac and lung dysfunction. This study examined the association of the increased release of TNF-alpha with increased myocardial and lung injury after CPB and its effect on postoperative morbidity. METHODS: Twenty patients undergoing elective coronary artery bypass grafting (CABG) were included in the study. Four intervals of blood samples were obtaind and assayed for TNF-alpha; white blood cells; C-reactive protein; and erythrocyte sedimentation rate. RESULTS: All patients were similar with regards to preoperative and intraoperative characteristics; and clinical outcomes were comparable. Plasma levels of TNF-alpha rose more than 20 pg/mL during and after standard CPB in 13 patients (group 1); whereas the plasma levels were less than 20 pg/mL in the remaining 7 patients (group 2) after CPB. The patients of the first group had increased mediastinal bleeding and prolonged intubation time compared to the other group. CONCLUSION: Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system; leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins; or by surgical trauma. Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare; but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level; C-reactive protein; and erythrocyte sedimentation rate after the operation; but in patients with a high level of TNF-alpha (more than 20 pg/mL); increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however; the specific level of TNF-alpha was first described as 20 pg/mL in this study.
Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare; but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level; C-reactive protein; and erythrocyte sedimentation rate after the operation; but in patients with a high level of TNF-alpha (more than 20 pg/mL); increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however; the specific level of TNF-alpha was first described as 20 pg/mL in this study.
Abacilar F; Dogan OF; Duman U; Ucar I; Demircin M; Ersoy U; Dogan R; Boke E.
Department of Cardiovascular Surgery; Izmir Sifa Hospital; Istanbul.
BACKGROUND: Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system; leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins; or by surgical trauma. Proinflammatory cytokines; such as tumor necrosis factor (TNF)-alpha; interleukin (IL)-6; and IL-8; play an important role in the inflammatory processes after CPB and may induce cardiac and lung dysfunction. This study examined the association of the increased release of TNF-alpha with increased myocardial and lung injury after CPB and its effect on postoperative morbidity. METHODS: Twenty patients undergoing elective coronary artery bypass grafting (CABG) were included in the study. Four intervals of blood samples were obtaind and assayed for TNF-alpha; white blood cells; C-reactive protein; and erythrocyte sedimentation rate. RESULTS: All patients were similar with regards to preoperative and intraoperative characteristics; and clinical outcomes were comparable. Plasma levels of TNF-alpha rose more than 20 pg/mL during and after standard CPB in 13 patients (group 1); whereas the plasma levels were less than 20 pg/mL in the remaining 7 patients (group 2) after CPB. The patients of the first group had increased mediastinal bleeding and prolonged intubation time compared to the other group. CONCLUSION: Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system; leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins; or by surgical trauma. Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare; but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level; C-reactive protein; and erythrocyte sedimentation rate after the operation; but in patients with a high level of TNF-alpha (more than 20 pg/mL); increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however; the specific level of TNF-alpha was first described as 20 pg/mL in this study.
Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare; but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level; C-reactive protein; and erythrocyte sedimentation rate after the operation; but in patients with a high level of TNF-alpha (more than 20 pg/mL); increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however; the specific level of TNF-alpha was first described as 20 pg/mL in this study.