Normothermia does not improve postoperative hemostasis nor does it reduce inflammatory activation in patients undergoing primary isolated coronary artery bypass

Gaudino, Mario; Zamparelli, Roberto; Andreotti, Felicita; Burzotta, Francesco; Iacoviello, Licia; Glieca, Franco; Benedett, Maria; Maseri, Attilio; Schiavello, R; Possati, Gianfederico

doi:10.1067/mtc.2002.120709

Cited by 27 publications

(16 citation statements)

References 19 publications

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“…The present analysis is a post-hoc comparison of data collected in a prospective randomized investigation 6 and the relatively small number of patients enrolled can limit the statistical power of the study. The failure to identify as predictors of postoperative AF some variables that have been linked with this arrhythmia in other series can in fact be the expression of the reduced statistical power of our series.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 During this period all patients scheduled to undergo isolated elective coronary artery bypass grafting (CABG) at our Institution were screened for inclusion. Exclusion criteria were: associated cardiac or noncardiac surgical procedures, age Ͼ80 years, single-vessel disease, emergent or urgent revascularization, left ventricular ejection fraction Ͻ0.30, carotid artery disease, previous cerebrovascular accident, chronic dialysis, hepatic failure, respiratory or renal insufficiency (defined respectively as a preoperative creatinine level Ն2.0 mg/dL and a preoperative pOՅ60 mm Hg or PCo 2 Ͼ50 mm Hg on room air and/or a preoperative FEV1Ͻ1.25 l or Ͻ75% of the normal value), hemorrhagic conditions, active infection and chronic anti-inflammatory and antifibrinolytic therapy.…”

Section: Patient Populationmentioning

confidence: 99%

“…As the FIFA study had as secondary endpoint the study of the effect of CPB temperature on postoperative inflammatory activation and fibrinolysis during CPB the nasopharingeal temperature was kept at 37°C in 53 cases and at 26°C in 57 according to a randomized sequence; of note, as reported elsewhere, no effect of CPB temperature on postoperative inflammation and hemostasis could be demonstrated. 6 Myocardial protection was always accomplished by anterograde isothermic intermittent blood cardioplegia.…”

Section: Operative Techniquementioning

confidence: 99%

“…C reactive protein, Interleukin-6, fibrinogen and others inflammatory and coagulative markers were determined preoperatively, 24, 48, and 72 hours after surgery and at hospital discharge following a methodology previously described 5,6 Postoperative Arrhythmias Evaluation…”

Section: Postoperative Evaluationsmentioning

confidence: 99%

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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%

Section: Patient Populationmentioning

confidence: 99%

Section: Operative Techniquementioning

confidence: 99%

Section: Postoperative Evaluationsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…This result is in accord with our findings in that reduced NO concentrations were found in HC patients until 24 h after the end of CPB. Treatment of patients with inhaled NO at low concentrations during and after bypass 17 , or with NO donor during reperfusion 13 , reduced myocardial injury 17 and the cardiac inflammatory reaction, as assessed by IL-6, IL-8 and TNF-a levels 13 . In line with this report, our study showed an association between systemically reduced NO production and increased duration of elevated cytokine levels in patients with hypothermia and crystalloid cardioplegia, although no significant differences were detected in clinical outcome between these patients and those with normothermia and blood cardioplegia.…”

Section: Discussionmentioning

confidence: 99%

Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass

et al. 2007

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Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypassEffect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass ABSTRACT Purpose: To investigate the effects of different conditions used during cardiopulmonary bypass (CPB) surgery on accompanying production of cytokine and nitric oxide (NO). Methods: Patients undergoing CPB for the first time were prospectively enrolled and divided into two groups according to CPB parameters performed: i) normothermia (36.5-37°C) with blood cardioplegia (NB group, n=10) and ii) hypothermia (29-31°C) with crystalloid cardioplegia (HC group, n=10). Plasma samples obtained following intubation (baseline), during (5 and 30 min) and after (4 and 24 h) CPB were assayed for cytokines (ELISA) and NO metabolites (Griess reaction). Results: Peak concentrations of interleukin (IL)-6 and IL-8 were reached at 4 h post CPB in both groups, but in the HC group those levels increased earlier and persisted for longer (24 h) compared to baseline (P < 0.05). IL-10 levels also increased at 4 h compared to baseline, but only significantly so in the HC group. NO metabolites were reduced in HC group at all time points compared to baseline (P < 0.05), while no significant differences were detected in the NB group. Conclusion: The association between increased systemic levels of cytokines and reduced NO production in the HC group suggests that different myocardial protection and/or perfusion temperature used during CPB may contribute to the extent of inflammatory response. Key words: Cardiopulmonary Bypass. Myocardium. Perfusion. Nitric Oxide. Cytokines. RESUMOObjetivo: Investigar a hipótese de que diferentes procedimentos durante o bypass cardiopulmonary (BCP) causa diferentes níveis de citocinas (IL) e óxido nítrico (NO). Métodos: Pacientes submetidas a BCP foram prospectivamente estudadas de acordo com bypass realizado sobre normotermia (36.5-37°C) com cardioplegia sanguínea (NB group, n=10) or hipotermia (29-31°C) com cardioplegia cristalóide (HC group, n=10). Amostras de Plasma foram obtidas após a intubação (linha de base), durante (5, 30 min) e após (4, 24 h) o BCP. Os ensaios foram realizados através de ELISA (IL) e metabólitos do NO (reação de Griess). Resultados: Os picos de concentrações de IL-6 and IL-8 estavam aumentados em 4 h pós BCP em ambos os grupos, mas no grupo HC estes níveis aumentaram precocemente e persistiram aumentadas por 24 h, comparado a linha de base (P<0.05). O nível de IL-10 também teve o pico em 4 h, mas estatisticamente significante somente no grupo HC, comparado a linha de base. Os metabólitos do NO estavam reduzidos no grupo HC, em todo o tempo, comparado a linha de base (P<0.05), enquanto nenhuma diferença estatisticamente significante foi detectada no grupo NB. Conclusão: A associação entre o aumento sistêmico dos níveis de citocina e a redução da produção de NO no grupo HC sugere que o tipo de proteção miocárdica e/ou ...

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Cardiopulmonary Bypass

2005

Manual of Perioperative Care in Adult Cardiac Surgery

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Recent data independently linking allogeneic blood use to increased morbidity and mortality after cardiopulmonary bypass (CPB) warrants the study of new methods to employ unique and familiar technology to reduce allogeneic blood exposure. The Hemobag † allows the open-heart team to concentrate residual CPB circuit contents and return a high volume of autologous clotting factors and blood cells to the patient.Fifty patients from all candidates were arbitrarily selected to receive the Hemobag † (HB) therapy. A retrospective control group of 50 non-Hemobag † (NHB) patients were matched to the HB group patient-by-patient for comparison according to surgeon, type of procedure, age, body surface area (BSA), body weight and CPB time. Many efforts to conserve blood (Cell Saver † and ANH) were employed in both groups. Post-CPB cell washing of circuit contents was additionally employed in the control group.There were no significant differences between the HB and NHB groups in regard to patient morphology, pre-op cell concentrations, distribution of surgeon or procedures (41% valve, 16% valve/coronary artery bypass graft (CABG), balance CABG), pump and ischemic times and Bayes National Risk scores. The average volume returned to the patient from the HB was 8179/198 mL (1 SD). Average processing time was 11 min. The Hemobag † contained an average platelet count of 2309/80 K/mm 3 , fibrinogen concentration of 4139/171 mg/dl, total protein of 8.09/2.8 gm/dl, albumin of 4.49/1.2 gm/dl and hematocrit of 439/7%. Factor VII, IX and X levels in three HB contents averaged 259% greater than baseline. Substantial reductions were achieved in both allogeneic blood product avoidance and cost to the hospital with use of the HB.Infusion of the Hemobag † concentrate appears to recover safely substantial proteins, clotting factor and cell concentration for all types of cardiac procedures, maintaining the security of a primed circuit. Perfusion (2005) 20, 343 Á/349.

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Normothermia does not improve postoperative hemostasis nor does it reduce inflammatory activation in patients undergoing primary isolated coronary artery bypass

Abstract: Normothermic systemic perfusion does not influence the clinical course or the extent of inflammatory and hemostatic activation in patients undergoing primary isolated coronary artery bypass.

Cited by 27 publications

References 19 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?

Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass

Cardiopulmonary Bypass

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