Peri-operative myocardial tissue injury and the release of inflammatory mediators in coronary artery bypass graft patients.
OBJECTIVE
This study was conducted to evaluate to what extent the ischemia-reperfusion injury resulting from the cardiopulmonary bypass (CPB) and aortic cross-clamping procedures during coronary artery bypass grafting (CABG) contributes to the systemic inflammatory response generally found in these patients.


METHODS
Serum levels of enzymes (CK and CK-MB) and non-enzymatic proteins (FABP and myoglobin) as markers of myocardial tissue injury, bactericidal permeability increasing protein (BPI) as an indicator of neutrophil activation, interleukin-6 (IL-6) as inducer of the acute phase response and lipopolysaccharide binding protein (LBP) as parameter of the acute phase response were measured in 15 low-risk CABG patients with cardiopulmonary bypass (CPB), and 17 low-risk CABG patients without CPB.


RESULTS
Already 0.5 h after reperfusion significantly increased plasma levels of all markers of myocardial tissue injury were noted in patients having surgery with CPB, but not in non-CPB patients. No significant differences were found between both groups for BPI and IL-6 levels in the early reperfusion period. BPI and IL-6 levels were higher in the non-CPB group on the first post-operative day (P < 0.05). However, no correlations were found for any marker of peri-operative tissue damage with either early neutrophil activation, or acute phase reactants.


CONCLUSIONS
Perioperative myocardial injury resulting from CPB and aortic cross-clamping in low-risk CABG patients does not contribute to the release of inflammatory mediators in these patients.
Fransen
E J
EJ
Department of Cardiothoracic Surgery, University Hospital Maastricht, The Netherlands. efr@scpc.azm.nl
Maessen
J G
JG
Hermens
W T
WT
Glatz
J F
JF
Buurman
W A
WA
D000209:Acute-Phase Proteins / Q000032:analysis; D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins / Q000032:analysis; D002315:Cardiopulmonary Bypass; D002352:Carrier Proteins / Q000097:blood; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000276:immunology / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D000071438:Fatty Acid-Binding Protein 7; D050556:Fatty Acid-Binding Proteins; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D015850:Interleukin-6 / Q000032:analysis; D007527:Isoenzymes; D008297:Male; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D008875:Middle Aged; D018996:Myelin P2 Protein / Q000097:blood; D015428:Myocardial Reperfusion Injury / Q000201:enzymology / Q000378:metabolism*; D009211:Myoglobin / Q000097:blood; D009363:Neoplasm Proteins; D018375:Neutrophil Activation; D018709:Statistics, Nonparametric; D025521:Tumor Suppressor Proteins; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D001798:Blood Proteins; D002352:Carrier Proteins; D003402:Creatine Kinase; D000071438:Fatty Acid-Binding Protein 7; D050556:Fatty Acid-Binding Proteins; D018836:Inflammation Mediators; D015850:Interleukin-6; D007527:Isoenzymes; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D018996:Myelin P2 Protein; D009211:Myoglobin; D009363:Neoplasm Proteins; D025521:Tumor Suppressor Proteins; D000099231:Lipopolysaccharide-Binding Protein; C107608:FABP7 protein, human; C021623:bactericidal permeability increasing protein