Cardiac interleukin-6 release and myocardial recovery after aortic crossclamping. Crystalloid versus blood cardioplegia.
BACKGROUND
Pro-inflammatory cytokines may play an important role in patient response to cardiopulmonary bypass (CPB). Since the myocardium is proposed to be a major source of cytokines, we studied the influence of the cardiolpegia type on interleukin-6 release and early myocardial recovery.


METHODS



METHODS
prospective, randomized study.


METHODS
university hospital, operative and intensive care.


METHODS
20 consecutive patients (3 females) scheduled for elective coronary artery bypass grafting (CABG), mean age 62.8+/-5 years, history of myocardial infarction 11/20, left ventricular ejection fraction 62.9+/-15%.


METHODS
patients were operated on using randomly either cold blood cardioplegia (B, n = 10) or cold crystalloid cardioplegia (C, n = 10).


METHODS
plasma levels of interleukin-6 (IL-6) were measured prior to CPB, after aortic declamping, after CPB, 1 hour, 6 hours and 12 hours postoperatively.


RESULTS
Groups were comparable with respect to demographic data, left ventricular function, number of grafts, CPB and aortic crossclamp time. Group B patients demonstrated significant lower IL-6 levels after 1 hour (210+/-108 vs. 578+/-443 pg/ml), 6 hours (204+/-91 vs. 1210+/-671 pg/ml) and 12 hours (174+/-97 vs. 971+/-623 pg/ml). Post-CPB cardiac index was superior in group B (3.9+/-0.3 vs. 3.2+/-0.3 l/min/m2, p<0.05) with similar doses of inotropes. Group B patients could earlier be weaned off respirator (10+/-4 vs. 13+/-4 hours, p<0.05) and showed minor blood loss (635+/-211 vs. 918+/-347 ml, p<0.05).


CONCLUSIONS
Inflammatory response to CPB is associated with delayed myocardial recovery. The use of blood cardioplegia may attenuate inflammatory reactions.
Liebold
A
A
Department of Cardio-Thoracic Surgery, University of Regensburg, Germany.
Langhammer
T h
Th
Brünger
F
F
Birnbaum
D E
DE
D015415:Biomarkers / Q000097:blood; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003080:Cold Temperature; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery; D000077324:Crystalloid Solutions; D005260:Female; D006321:Heart / Q000503:physiopathology; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007552:Isotonic Solutions; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011446:Prospective Studies; D016277:Ventricular Function, Left
D015415:Biomarkers; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D015850:Interleukin-6; D007552:Isotonic Solutions; D010952:Plasma Substitutes