Inflammatory response after coronary revascularization with or without cardiopulmonary bypass

Ascione, Raimondo; Lloyd, Clinton; Underwood, Malcolm J.; Lotto, A; Pitsis, Antonis A.; Angelini, Gianni D

doi:10.1016/s0003-4975(00)01152-8

Cited by 447 publications

(288 citation statements)

References 26 publications

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“…Recently a large prospective randomized series demonstrated a significantly lower incidence of AF after off pump coronary artery surgery compared with traditional CABG, 19 suggesting the hypothesis that the use of the cardiopulmonary bypass and the consequent systemic inflammatory reaction 20 can play a major role in determining postoperative atrial arrhythmias (although this finding is still debated on the basis of the conflicting results reported by others studies). [21][22][23] The observation of a link between postoperative complement activation and atrial arrhythmias in CABG patients 4 and the evidence derived from the analysis of atrial specimens from patients with isolated AF that atrial myocarditis can constitute the histological background of this arrhythmia, 3 led further support to an "inflammatory" theory of the pathophysiology of postoperative AF.…”

Section: Discussionmentioning

confidence: 99%

The −174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication?

et al. 2003

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Background-It has been suggested that inflammation can have a role in the development of atrial arrhythmias after cardiac surgery and that a genetic predisposition to develop postoperative complications exists. This study was conceived to verify if a potential genetic modulator of the systemic inflammatory reaction to cardiopulmonary bypass (the Ϫ174 G/C polymorphism of the promoter of the Interleukin-6 gene) has a role in the pathogenesis of postoperative atrial fibrillation (AF). Patients and Results-In 110 primary isolated coronary artery bypass patients the Ϫ174G/C Interleukin-6 promoter gene variant was determined. Interleukin-6, fibrinogen and C-reactive protein plasma levels were determined preoperatively, 24, 48, and 72 hours after surgery and at discharge. Heart rate and rhythm were continuously monitored for the first 36 to 48 hours; daily 12-lead electrocardiograms were performed thereafter until discharge. GG, CT, and CC genotypes were found in 62, 38, and 10 patients, respectively. Multivariate analysis (which included genotype, age, sex, and classical risk factors for AF) identified the GG genotype as the only independent predictor of postoperative AF. The latter occurred in 33.9% of GG versus 10.4% of non-GG patients (hazard ratio 3.25, 95%CI 1.23 to 8.62). AF patients had higher blood levels of Interleukin-6 and fibrinogen after surgery (PϽ0.001 for difference between the area under the curve). Conclusion-The

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Section: Discussionmentioning

confidence: 99%

The −174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication?

et al. 2003

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“…In spite of the optimum results over 15 years of follow up [17], numerous publications have demonstrated deleterious effects of cardiopulmonary bypass [1][2][3][4].…”

Section: Commentsmentioning

confidence: 99%

“…Numerous articles published over the last few years associated cardiopulmonary bypasses with a series of complications observed in patients who underwent coronary artery bypass grafting (CABG) [2][3][4]. After the pioneering works of BUFFOLO et al [5] and BENETTI [6], off-pump CABG became of interest world-wide, with investigations carried out by many centers [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

<![CDATA[<B>Total myocardium revascularization without extracorporeal circulation</B>: <B>five-year experience</B>]]>

Milani¹,

Brofman²,

Varela³

et al. 2005

Braz. j. cardiovasc. surg.

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Objective: To evaluate the immediate postoperative results of off-pump myocardium revascularization surgery by analyzing complications and mortality.Method: A total of 1440 patients were submitted to offpump myocardium revascularization. The surgical technique consisted in proximal occlusion of the approached artery, the application of the LIMA graft in the posterior pericardial deflection and stabilization of the target artery with a suction stabilizer. The distal anastomoses were performed first.Results: Among the patients evaluated, 924 were male and 516 were female, with a mean age of 63.12 ± 8.76 years. The ejection fraction was normal in 749 patients, 740 (51.4%) patients had suffered previous myocardial infarction and 687 (47.6%) patients were in functional class III or IV. The mean EuroSCORE was 4.93 ± 3.32. The mean number of distal anastomoses was 3.12 ± 1.23 per patient. A total of 1173 (81.5%) patients remained less than 12 hours on mechanical ventilation and among these, 888 (61.7%) remained for less than six hours. The stay in the ICU was of one night for 330 (22.8%) patients, for two nights for 930 (64.6%) patients and 182 (12.4%) patients remained for three or more nights. In regards to complications, three (0.2%) patients presented with renal insufficiency, six (0.4%) patients suffered strokes, nineteen (1.3%) patients were reoperated for bleeding, nineteen (1.3%) patients had mediastinitis, eighteen (1.25%) patients suffered severe myocardial infarction and 212 (14.7%) presented atrial fibrillation. There were 50 (3.5%) deaths, 29 (2.5%) of them being among the 1148 patients operated electively, 9 (4.7%) among 190 patients submitted to coronary re-operation and 12 (11.7%) among 102 patients undergoing emergency operations.Conclusion: With the evolution of biomedical technological, all the vessels of the heart are now approached. These data suggest that the operation for myocardial revascularization is safe and efficient. It can be applied to all patients who need coronary surgery, with low rates of complication and mortality.

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“…The use of ECC, however, was associated with significantly higher intraoperative blood glucose levels (Table 4). Although the corticosteroid dose of the protocol can explain that association, ECC per se is one of the major triggers of pro-inflammatory activity in surgery, with substantial elevations in cytokines and circulating interleukines 17 , thus, higher blood glucose levels are expected with ECC use. Thus, patients were subdivided according to ECC use in the surgical procedure for analyzing the relation between the mean intraoperative blood glucose level and the occurrence of specific complications of the major body systems in each situation (Tables 6 and 7).…”

Section: Perioperative Periodmentioning

confidence: 99%

Glicemia perioperatória e complicações pós-operatórias em cirurgia cardíaca pediátrica

Alves¹,

Cerqueira²,

Kraychete³

et al. 2011

Arq. Bras. Cardiol.

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Background: Anesthesia for pediatric cardiac surgery is systematically performed in severely ill patients under abnormal physiological conditions. In the intraoperative period, there are significant variations in blood volume, body temperature, plasma composition, and tissue blood flow, in addition to activation of inflammation, with important consequences. Serial measurements of blood glucose levels can indicate states of exacerbation of the neuroendocrine-metabolic response to trauma, serving as prognostic markers of morbidity in that population.

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Inflammatory response after coronary revascularization with or without cardiopulmonary bypass

Cited by 447 publications

References 26 publications

The −174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication?

The −174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication?

<![CDATA[<B>Total myocardium revascularization without extracorporeal circulation</B>: <B>five-year experience</B>]]>

Glicemia perioperatória e complicações pós-operatórias em cirurgia cardíaca pediátrica

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