Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass.
BACKGROUND
Tumor necrosis factor-alpha has been implicated in complications seen after cardiac operations with cardiopulmonary bypass. The release of tumor necrosis factor-alpha and its possible effects were studied in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.


METHODS
Twenty patients were studied, 10 with (group 1) and 10 without cardiopulmonary bypass (group 2). Serial blood samples were obtained before, during, and up to 48 hours after operation. Circulating tumor necrosis factor-alpha levels, leukocyte counts, and erythrocyte sedimentation rates were measured. Hemodynamic variables (blood pressure and heart rate), temperature, orotracheal intubation time, postoperative bleeding, and inotropic drug requirements were compared.


RESULTS
Serum levels of tumor necrosis factor-alpha were detected in 6 patients (60%) in group 1 and none in group 2. The patients in group 1 had more hypotension than those in group 2 (7.4 +/- 1.0 mm Hg versus 8.5 +/- 0.7 mm Hg), required more inotropic drugs (8 patients versus 1 patient), and had a higher heart rate (114 +/- 8 beats per minute versus 98 +/- 10 beats per minute), a higher temperature (37.1 degrees +/- 0.5 degrees C versus 36.6 degrees +/- 0.3 degrees C), increased postoperative bleeding (820 +/- 120 mL versus 360 +/- 84 mL), a longer orotracheal intubation time (13.6 +/- 2.2 hours versus 9.3 +/- 1.4 hours), and a more pronounced leukocytosis.


CONCLUSIONS
Cardiopulmonary bypass induces the whole-body inflammatory response through the release of tumor necrosis factor alpha, resulting in adverse systemic effects.
Discipline of Cardiovascular Surgery, Escola Paulista de Medicina and São Paulo Hospital, Federal University of São Paulo, Brazil.
L A
LA
Brasil
W J
WJ
Gomes
R
R
Salomão
E
E
Buffolo
D001794:Blood Pressure / Q000502:physiology; D001799:Blood Sedimentation; D001831:Body Temperature / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007442:Intubation, Intratracheal; D007958:Leukocyte Count; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D019106:Postoperative Hemorrhage / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000378:metabolism / Q000502:physiology*
D014409:Tumor Necrosis Factor-alpha