Systemic Inflammation After On-Pump and Off-Pump Coronary Bypass Surgery: A One-Month Follow-Up

Parolari, Alessandro; Camera, Marina; Alamanni, Francesco; Naliato, Moreno; Polvani, Gianluca; Agrifoglio, Marco; Brambilla, Marta; Biancardi, Carlo M.; Mussoni, L.; Biglioli, Paolo; Tremoli, Elena

doi:10.1016/j.athoracsur.2007.04.048

Cited by 101 publications

(69 citation statements)

References 16 publications

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“…Postoperative activation of inflammation persisting several days after coronary bypass surgery was not affected by the surgical strategy, 18 but as we show might be influenced by IL-6 polymorphism.…”

Section: Discussionmentioning

confidence: 85%

The increased plasma C-reactive protein and interleukin-6 levels in patients undergoing coronary artery bypass grafting surgery are associated with the interleukin-6−174G > C gene polymorphism

et al. 2010

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Background: The interleukin-6 (IL-6) promoter 2174G/C polymorphism (rs1800795) is associated with enhanced systemic inflammatory response to injury. However, data on the effect of this polymorphism on inflammatory markers in patients undergoing coronary artery bypass grafting surgery (CABG) are inconsistent. The aim of our study was to investigate whether 2174G/C IL-6 polymorphism affects plasma IL-6 and C-reactive protein (CRP) concentrations in patients undergoing CABG. Methods: A total of 179 consecutive white patients (77% men, aged 65 + 8.6 standard deviation [SD] y) scheduled for elective isolated CABG were studied. Pre-and postoperative CRP and IL-6 levels were analysed in relation to the 174G/C IL-6 polymorphism determined by using TaqMan single-nucleotide polymorphism genotyping technique. Results: The genotype distribution was as follows: GG -46 (26%), GC -93 (52%) and CC -40 (22%). The C allele carriers had higher baseline CRP (4.1 + 0.35 versus 2.4 + 0.59 mg/L, P ¼ 0.02) and IL-6 levels (3.0 + 0.17 versus 2.2 + 0.3 pg/mL, P ¼ 0.02) than GG patients. Five to seven days after CABG, CRP levels rose by 54% (P ¼ 0.03), and IL-6 levels tended to be higher (P ¼ 0.07) in 2174C allele carriers than the non-carriers. There were no associations between 2174G/C IL-6 polymorphism and any demographic-, clinical-or procedure-related variables as well as major adverse cardiovascular events. Multivariate regression analysis, including sex, age, body mass index, hypercholesterolaemia, smoking, hypertension diabetes, identified CG þ CC genotype as the only independent predictor of preoperative CRP and IL-6 levels. Conclusions: The presence of the 2174C allele determines to some extent higher plasma CRP and IL-6 concentrations pre-and postoperatively in CABG patients.

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Section: Discussionmentioning

confidence: 85%

The increased plasma C-reactive protein and interleukin-6 levels in patients undergoing coronary artery bypass grafting surgery are associated with the interleukin-6−174G > C gene polymorphism

et al. 2010

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“…The argument that CPB-induced systemic inflammation causes cognitive decline is further weakened by a failure to show significant differences in systemic inflammatory markers between patients randomised to on-pump or off-pump surgery [58]. Unfortunately, the strength of evidence from this study was undermined by the choice of sampling times, that may have missed potential early postoperative differences (inflammatory markers were only measured at baseline, after protamine administration and then after 4, 8 and 30 days).…”

Section: Inflammationmentioning

confidence: 88%

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

Harten¹,

2012

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SummaryPostoperative cognitive dysfunction is receiving increasing attention, particularly as it mainly affects the (growing) elderly population. Until recently, cognitive deficits after cardiac surgery were thought to be caused by physiological disturbances associated with the cardiopulmonary bypass technique. Although the technique of 'off-pump' coronary revascularisation may potentially be associated with improved outcome, long-term follow-up studies have failed to demonstrate a significant reduction in the incidence of postoperative cognitive dysfunction. The focus of research is thus shifting from cardiopulmonary bypass to other factors common to both techniques, such as surgery, anaesthesia and patient-related predisposing factors. Priming of the immune system by ageing and atherosclerosis may result in an exaggerated systemic and cerebral inflammatory response to cardiac surgery and anaesthesia, causing neuronal loss or dysfunction resulting in cognitive dysfunction. We briefly discuss the evidence for cardiopulmonary bypass-related neuronal injuries in adult cardiac surgery patients, and review the evidence that immune priming is a key factor in the pathogenesis of cognitive dysfunction after cardiac surgery.

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“…This is the first time that mechanical strain has been shown to induce CRP expression in vessels, although the phenomenon has been suggested indirectly from clinical phenomena. Increased serum CRP was observed in patients with atherosclerosis (Lusic et al, 2006), hypertension (Li et al, 2005), aneurysms (Vainas et al, 2003), and vein grafts in coronary bypass surgery (Parolari et al, 2007) in which mechanical strain increased. More directly, patients with elevated pulse pressure, which indicates significantly increased mechanical strain on vessels, have been shown to have higher serum hsCRP levels (Abramson et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Mechanical Strain Induces Expression of C-Reactive Protein in Human Blood Vessels

Huang¹,

Luo²,

Gu³

et al. 2009

J Pharmacol Exp Ther

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C-reactive protein (CRP) is a powerful independent risk factor for cardiovascular diseases. Elevated mechanical strain on vessels induces the local expression of proinflammatory cytokines. We hypothesized that mechanical strain on vessels may induce local CRP expression. Human saphenous vein and internal mammary artery (IMA) rings were stretched in vitro with a mechanical strength of 1, 3, or 5 g. Reverse transcriptionpolymerase chain reaction and enzyme-linked immunosorbent assay results showed that mechanical stretching significantly induced CRP mRNA and protein expression in the saphenous vein and IMA rings in a strength-dependent manner reaching a maximum at a mechanical strength of 3 g, but CRP expression returned at strengths of Ͼ5 g. In vessels, mechanical straininduced CRP expression was blocked by two stretch-activated ion channel (SAC) blockers: GdCl 3 and streptomycin. Mechanical strain also increased activation of nuclear factor B (NF-B), which was detected with a nonradioactive NF-B p50/p65 EZ-TFA transcription factor assay. Mechanical strain-induced NF-B activation was blocked by SAC blockers and the NF-B inhibitor (SN50, H-Ala-Ala-Val-Ala-Leu-Leu-Pro-Ala-Val-LeuLeu-Ala-Leu-Leu-Ala-Pro-Val-Gln-Arg-Lys-Arg-Gln-Lys-LeuMet-Pro-OH). SN50 also blocked mechanical strain-induced CRP expression in vessels. In conclusion, mechanical strain induces CRP expression in IMAs and saphenous veins by activating the SAC-induced NF-B pathway.

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Systemic Inflammation After On-Pump and Off-Pump Coronary Bypass Surgery: A One-Month Follow-Up

Cited by 101 publications

References 16 publications

The increased plasma C-reactive protein and interleukin-6 levels in patients undergoing coronary artery bypass grafting surgery are associated with the interleukin-6−174G > C gene polymorphism

The increased plasma C-reactive protein and interleukin-6 levels in patients undergoing coronary artery bypass grafting surgery are associated with the interleukin-6−174G > C gene polymorphism

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

Mechanical Strain Induces Expression of C-Reactive Protein in Human Blood Vessels

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