Preoperative oral pentoxifylline for management of cytokine reactions in cardiac surgery.
BACKGROUND
Cardiopulmonary bypass may lead to many inflammatory responses that may cause myocardial dysfunction after open heart surgery. We aimed to investigate the effect of preoperative pentoxifylline treatment to reduce the occurrence of cardiopulmonary bypass-induced inflammatory response.


METHODS
In a prospective, randomized study, 40 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (study group, n = 21) or not (control group, n = 19). Pretreatment with pentoxifylline (800 mg/day orally) was started 5 days before the operation. Blood samples for measurements of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8 from the arterial line, and venous blood samples for creatine kinase (CK) and CK isoenzyme fraction MB (CK-MB) were taken in both groups at 5 different time points. Hemodynamic parameters were measured with the thermodilution technique.


RESULTS
TNF-alpha, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a greater increase in the control group (P < .05). There were no significant differences between the groups for the values of CK-MB and hemodynamic parameters.


CONCLUSIONS
We conclude that pretreatment with oral pentoxifylline before cardiac surgery inhibits proinflammatory cytokine release caused by cardiopulmonary bypass and has some beneficial effects in protecting the myocardium during the cardioplegic arrest period in open-heart surgery, without affecting postoperative hemodynamics.
Iskesen
Ihsan
I
Department of Cardiovascular Surgery, Celal Bayar University, School of Medicine, Manisa, Turkey. iskesen@yahoo.com
Kurdal
Adnan Taner
AT
Kahraman
Nail
N
Cerrahoglu
Mustafa
M
Sirin
Bekir Hayrettin
BH
D000284:Administration, Oral; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood*; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood* / Q000209:etiology* / Q000517:prevention & control; D010431:Pentoxifylline / Q000008:administration & dosage*; D011292:Premedication / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome
D016207:Cytokines; D016166:Free Radical Scavengers; D010431:Pentoxifylline