Can cardioplegia management influence cytokine responses during clinical cardiopulmonary bypass?
BACKGROUND
Cytokines play an important role in the inflammatory response associated with cardiopulmonary bypass (CPB) and may contribute to postoperative complications. Although it has been shown that the production of tumor necrosis factor a (TNF-a) and interleukin (IL)-6 were higher following normothermic CPB than hypothermic CPB, whether different cardioplegic management could influence the release of cytokines remains unknown.


METHODS
We compared the blood concentrations of four cytokines (TNF-a, IL-6, IL-8, and IL-10) in two groups of patients undergoing complete revascularization with CPB in the same study period. Seventeen patients received cold crystalloid cardioplegia at a Belgian center (group-CC), while 21 patients received warm blood cardioplegia at a center in Hong Kong (group-WB). Blood samples were collected before and after surgery in each patient.


RESULTS
There were no differences between the 2 groups in terms of age, sex ratio, number of grafts, duration of CPB and aortic crossclamping. All patients survived their hospital stay. The levels of TNF-a, IL-6 and IL-8 after surgery were higher in group-CC than in group-WB. However, IL-10 levels were significantly lower at the end of surgery in group-CC than in group-WB.


CONCLUSIONS
Our data suggest that the use of warm blood cardioplegia, rather than cold crystalloid cardioplegia, may reduce the inflammatory response to CPB. This observation warrants future randomized investigation to determine its clinical relevance.
Wan
S
S
Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Yim
A P
AP
Arifi
A A
AA
Lee
T W
TW
Huynh
C H
CH
DeSmet
J M
JM
LeClerc
J L
JL
Vincent
J L
JL
D001769:Blood; D002315:Cardiopulmonary Bypass; D000077324:Crystalloid Solutions; D016207:Cytokines / Q000097:blood*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D000077324:Crystalloid Solutions; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10