The effects of pentoxifylline on the myocardial inflammation and ischemia-reperfusion injury during cardiopulmonary bypass.
BACKGROUND
Pentoxifylline (Ptx) decreases necessity of cell energy and inflammatory reactions via inhibition of 5'-nucleotidase (5'-NT). The aim of this study is to investigate whether the addition of Ptx into the cardioplegic solutions avoids myocardial inflammatory reactions and ischemia/reperfusion (I/R) injury during extracorpereal circulation.


METHODS
Between December 1999 and February 2002, we operated 75 patients with the diagnoses of atrial septal defect (ASD), ventricular septal defect (VSD), valve disease, and coronary disease. The average age of patients was 42.4 and male-female ratio was 1: 1.5. The patients were divided into two groups, which were the study group (n = 40) and the control group (n = 35). We used cold blood cardioplegia mixed with St. Thomas' Hospital II cardioplegic solution for both of the groups. Ptx was added into the cardioplegic solution (500 mg/L) in the study group. Interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrotisis factor-alpha (TNF-alpha) levels in coronary sinus blood samples during cross-clamp time (X-clamp) and after releasing of it and tissue TNF-alpha in the right atrial appendix biopsy material that was taken after X-clamp were studied to compare the both groups.


RESULTS
After releasing X-clamp, results of blood TNF-alpha, IL-6, and IL-8 of both groups were statistically significant (p < 0.005). At the pathological examination, we also observed that the amount of tissue TNF-alpha in the control group (66 +/- 17.1) was much higher than the study group (16.6 +/- 5.9, p <0.005).


CONCLUSIONS
These results show that Ptx may be added into cardioplegic solution to avoid the myocardial inflammation and I/R injury during open heart surgery.
Ustunsoy
Hasim
H
Department of Cardiovascular Surgery, Gaziantep University Medical Faculty, Gaziantep, Turkey. hustunsoy@yahoo.com
Sivrikoz
M Cumhur
MC
Tarakcioglu
Mehmet
M
Bakir
Kemal
K
Guldur
Emin
E
Celkan
M Adnan
MA
D015720:5'-Nucleotidase / Q000037:antagonists & inhibitors; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000378:metabolism / Q000473:pathology; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D009206:Myocardium / Q000473:pathology*; D010431:Pentoxifylline / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015415:Biomarkers; D004791:Enzyme Inhibitors; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D015720:5'-Nucleotidase; D010431:Pentoxifylline