Epicardial ganglionated plexus stimulation decreases postoperative inflammatory response in humans.
BACKGROUND
Surgical cardiac revascularization produces a high degree of systemic inflammation and the secretion of several cytokines. Intensive postoperative inflammation may increase the incidence of postoperative atrial fibrillation and favor organ dysfunctions. No data documenting the anti-inflammatory properties of epicardial vagal ganglionated plexus stimulation are available.


OBJECTIVE
To verify the feasibility and safety of postoperative inferior vena cava-inferior atrial ganglionated plexus (IVC-IAGP) burst stimulation and the effectiveness of this approach in reducing serum levels of inflammatory cytokines.


METHODS
In 27 patients who were candidates for off-pump surgical revascularization, the IVC-IAGP was located during surgery, a temporary wire was inserted, and a negative atrioventricular node dromotropic effect was obtained in 20 patients on applying high-frequency burst stimulation. In 5 patients atrial fibrillation or phrenic nerve stimulation was induced, and the remaining 15 patients served as the experimental group. Twenty additional patients underwent off-pump surgical revascularization without IVC-IAGP stimulation and served as the control group. On arrival in the intensive care unit, the experimental group underwent IVC-IAGP stimulation for 6 hours. Blood samples were collected at different times.


RESULTS
The serum levels of cytokines were not statistically different at baseline and on arrival in the intensive care unit between the groups, while they proved statistically different after 6 hours of stimulation: interleukin-6 (EG: 121 ± 71 pg/mL vs CG: 280 ± 194 pg/mL; P = .004), tumor necrosis factor-α (EG: 2.68 ± 1.81 pg/mL vs CG: 5.87 ± 3.48 pg/mL; P = .003), vascular endothelial growth factor (EG: 93 ± 43 pg/mL vs CG: 177 ± 86 pg/mL; P = .002), and epidermal growth factor (EG: 79 ± 48 pg/mL vs CG: 138 ± 76 pg/mL; P = .012).


CONCLUSIONS
Prolonged burst IVC-IAGP stimulation after surgical revascularization appears to be feasible and safe and significantly reduces inflammatory cytokines in the postoperative period.
Cardiology Department, Arrhythmology Unit, S. Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy. rossi.ptr@gmail.com
Pietro
P
Rossi
Alessandro
A
Ricci
Ruggero
R
De Paulis
Elsie
E
Papi
Herribert
H
Pavaci
Daniele
D
Porcelli
Giancarlo
G
Monari
Daniele
D
Maselli
Alessandro
A
Bellisario
Franco
F
Turani
Saverio
S
Nardella
Paolo
P
Azzolini
Gianfranco
G
Piccirillo
Raffaele
R
Quaglione
Sergio
S
Valsecchi
Stefano
S
Bianchi
D000368:Aged; D015415:Biomarkers / Q000097:blood; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003327:Coronary Disease / Q000097:blood / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005725:Ganglia, Autonomic; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000294:innervation; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D055536:Vagus Nerve Stimulation / Q000379:methods*
D015415:Biomarkers; D016207:Cytokines