[Randomized controlled trial for the effect of amrinone and aprotinin on proinflammatory cytokine release in patients with prosthetic valve replacement during perioperative period].
OBJECTIVE
To explore the effect of amrinone and aprotinin on whole-body inflammatory response in the patients with prosthetic valve replacement during perioperative period.


METHODS
24 patients undergoing prosthetic valve replacement were randomized to control group (group A, n = 8), aprotinin group (group B, n = 8) and amrinone combined with aprotinin group (group C, n = 8). In the aprotinin group, 3 x 10(6) of aprotinin was added to the priming solution of the extracorporeal circulation (ECC). In the amrinone combined with aprotinin group 3 x 10(6) of aprotinin was added to the priming solution of the ECC and amrinone began with a bolus of 1 mg/kg followed by a maintenance infusion of 8 micrograms/(kg.min). The control group received an equivalent prime volume without aprotinin. Venous blood samples were drawn before the operation, at the end of ECC, 1 hour after the end of ECC, and one day after the operation respectively. Enzyme-linked immunosorbent assay techniques were used to measure each of the cytokines.


RESULTS
Before ECC, there were no differences of the levels of IL-6 and IL-8 among groups (P > 0.05). After ECC, the levels of IL-6 and IL-8 increased significantly in all groups (P < 0.05). The levels on day one after the operation were still higher than those before the operation in all groups (except the level of IL-8 in group C), but no statistical significance was observed. (P > 0.05). At 1 hour after the end of ECC, the level of IL-6 in group B was lower than that in group A, and the level of IL-6 in group C was lower than that in group B, but there was no statistically significant difference (P > 0.05); At the end of ECC, the level of IL-8 in group B was lower than that in group A and the level of IL-8 in group C was lower than that in group B, but no significant difference was noted (P > 0.05). It was also observed that the level of IL-8 was lower in group C than group A or B at 1 hour after the end of ECC.


CONCLUSIONS
Although amrinone and aprotinin have antiinflammatory activity, but pump prime only aprotinin or aprotinin combined with amrinone may fall in preventing proinflammatory cytokine release (IL-6, IL-8) completely in patients with prosthetic valve replacement during ECC perioperative period.
Xiao
X
X
Division of Cardiothoracic Surgery, First Affiliated Hospital, WCUMS, Chengdu 610041, China.
Luo
C
C
Zhuang
X
X
Yin
D
D
Chen
Y
Y
Cao
G
G
Huang
X
X
Tian
Z
Z
Shi
Y
Y
D000328:Adult; D000676:Amrinone / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008875:Middle Aged; D011184:Postoperative Period
D002316:Cardiotonic Agents; D015850:Interleukin-6; D016209:Interleukin-8; D007611:Aprotinin; D000676:Amrinone