The Comparison of Inflammatory Response in Off-Pump and OnPump Coronary Bypass Surgery

Year 2012, Volume: 14 Issue: 3, 43 - 47, 01.12.2012

Hikmet Selçuk Gedik Gökhan Lafcı Adnan Yalçınkaya Adem İlkay Diken Kerim Çağlı Kemal Korkmaz

Abstract

Objective: In this study, tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) levelswhich are important in inflammatory response to off pump and on pump coronary by-passsurgery, were compared and their clinical reflections were examined.Study plan: Forty patients who underwent coronary artery by-pass grafting in our clinic, wereincluded in the study. The first group included on-pump patients (Group I, n=20) and secondgroup included off pump patients (group II, n=20). In both groups the day before surgery andpost operative sixth hour of tumor necrosis factor, as well as the day before surgery, postoperative first and third days of C - reactive protein levels were measured.Results: In the comparison of TNF- α levels, while the preoperative levels were not significantlydifferent in both groups (p=0.098), postoperative levels of Group 1 were significantly higher(p=0.016). In both groups any significant difference between pre operative CRP levels (p=0.074)was not found. In Group I, the first and third postoperative day CRP levels were significantlyhigher (p=0.021-p=0.019). White blood cell levels of each group at preoperative (p=0.094), postoperative 1st day (p=0.091) and post operative 3rd day (p=0.095) were not significantlydifferent.Conclusion: As an indicator of inflammatory response, the tumor necrosis factor- α and Creactive protein levels were significantly higher in operations using cardiopulmonary by-passthan surgeries on beating heart

Keywords

Off-pump coronary surgery, On-pump Coronary Surgery, Inflammatory Response

Off-Pump ile On-Pump Koroner Bypass Cerrahisinde İnflamatuar Yanıtın Karşılaştırılması

Abstract

Amaç: Bu çalışmamızda off-pump ve on-pump yöntemi ile koroner bypass operasyonu yapılanhastalardaki inflamatuar yanıtta önemli olan tümör nekrozis faktör-alfa (TNF-α) ile C–reaktifprotein (CRP) değerleri karşılaştırılarak klinik yansımaları incelenmiştir.Çalışma planı: Kliniğimizde koroner bypass operasyonu yapılan 40 hasta çalışmaya alındı.Birinci grup on- pump hastaları (Grup I, n=20), ikinci grup ise off pump (Grup II, n=20)hastalarından oluşturuldu. Her iki grupta operasyondan bir gün önce ve postoperatif 6.saattetümör nekrozis faktör, ayrıca operasyondan bir gün önce, postoperatif 1. ve 3. günlerde C-reaktifprotein ile akyuvar düzeylerine bakıldı.Sonuçlar: Karşılaştırdığımız tümör nekrozis faktör düzeylerinde preoperatif dönemde anlamlıbir fark izlenmezken (p=0.098), postoperatif dönemdeki tümör nekrozis faktör düzeyleri GrupI’de anlamlı olarak daha yüksek bulundu (p=0.016). Her iki gruptaki preoperatif C-reaktifprotein düzeyleri arasında anlamlı bir fark bulunmazken (p=0.074), Grup I’de postoperatif 1.ve 3. gündeki C-reaktif protein düzeyleri anlamlı olarak daha yüksek bulundu (p=0.021 p:0.019). Her iki grubun preoperatif (p=0.094), postoperatif 1.gün (p=0.091) ve postoperatif3.gün (p=0.095) white blood cell düzeyleri arasında istatistiksel olarak anlamlı bir farksaptanmadı.Tartışma: Kardiyo-pulmoner by-pass kullanılarak yapılan operasyonlarda inflamatuar yanıtınbir göstergesi olan tümör nekrozis faktör ve C-reaktif protein düzeyleri atan kalpte yapılanlaraoranla anlamlı derecede yüksek bulunmuştur

Keywords

Off-Pump Koroner Cerrahi, On-Pump Koroner Cerrahi, İnflamatuar Yanıt

References

• Ulaş MM, Çağlı K. Bahar İ. Şener E. Kardiyopulmoner Bypass ve İnflamatuvar Süreç. İstanbul Üniversitesi Kardiyoloji Enstitüsü Dergisi, Haziran 2004; 3: (9) 19–23.
• Marcus AJ. Thrombosis and inflammation as multicellular processes: significance of cell-cell interactions. Semin Hematol 1994;31.261–9.
• Warltier DC, Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002;97.215–52.
• Abbas AK, Lichtman AH, Pober JS. Cytokines that mediate natural immunity. In: Martin J Wonsiewicz, editor. Cellular and Molecular Immunology, effective mechanisms of immune responses. 1991;p.232.
• Chaudhary D, Verma GR, Gupta R, et al. Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholesistectomy. Aust N Z J Surg 1999;69.369–372
• Wei M, Kuukasjarvi P, Pehkonen E, Kaukinen S, Laine S, Tarkka M. Cytokine responses in low-risk coronary artery bypass surgery. Circulation 2000;102:III 95
• Diegeler A, Doll N, Rauch T, et al. Humoral immun response during coronary artery bypass grafting, a comparison of limited approach, ‘off Pump’ technique and conventional cardiopulmonary bypass. Ciculation 2000,7;102(19 uppl 3):III 1–4
• Karube N, Adachi R, Ichikawa, et al. Measurement of cytokine levels by coronary sinus blood sampling during cardiac surgery with cardiopulmonary bypass. ASAIO J 1996;42:M 787–791
• Innes Y. P. Wan, Ahmed A. Arifi, Song Wan, Johnson H. Y. Yip, Alan D. L. Sihoe, K.H. Thung, Eric M. C. Wong and Anthony P. C. Yim. Beating heart revascularization with or without cardiopulmonary bypass: Evaluation of inflammatory response in a prospective randomized study J Thorac Cardiovasc Surg 2004;127:1624–1631
• Levine B, Kalman J, Mayer L, et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Eng J Med 1990;323:236–241
• Wen S, Wang J, Zhang C. Dynamic change of tumor necrosis factor and endotelin during perioperative period in patients undergoing coronary artery bypass grafting. Zhonghua Yi Xue Za Zhi 2001,10;81(23):1450–1452
• Abacilar F, Dogan OF, Duman U, Ucar I, Demircin M, Ersoy U, Dogan R, Boke E. The changes and effects of the plasma levels of tumor necrosis factor after coronary artery bypass surgery with cardiopulmonary bypass. Heart Surg Forum. 2006;9(4):E 703–9.
• Gheno G, Liberdoni M, Zeppellini R. CRP on admission as a predictor of in hospital death in the elderly with acute myocardial infarction. Cardiologia 1999;44(12):1023–8
• Krause KJ. CRP a screening test for coronary disase. J Insur Med 2001;33,4–11
• Toss H, Lindahl B, Siegbahn. Prognostic influence of increased fibrinogen and CRP levels in unstable coronary artery disease. Circulation 1997; 96: 4204–10
• Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362:801-9
• Morrone G, Ciliberto G, Oliviero S. Recombinant IL–6 regulates the transcriptional activation of a set of human acute phase genes. J.Biol Chem 1988; 263: 12554–8
• Heeschen C, Hamm CW, Bruemmer j, Simoons MC,. Predictive value value of CRP and Troponin T in patients with unstable angina: a comparative analysis. J Am Coll Cardiol 2000;35(&): 1535–42
• Griselli M, Herbet V, Hutchinson WL, Taylor Km. CRP and complement ase important mediators of tissue damage in acute myocardial infarction. J Exp. Med. 1999; 190 (12):1733–40
• Burius P, Velthuis H, Yazdanbakhsh AP, Jansen PG. Activation of the complement system during and after CPB Surgery: Postsurgery activation involves C-reactive protein and is associated with postoperative arrythmia. Circulation 1997; 96(10): 3542–8
• Boeken U. Feindt P., Zimmermann N., Kalveit G., Petzold T., Gams E. Increased preoperative C-reactive protein values without signs of an infection and complicated course after cardiopulmonary bypass operations. Eur J Cardiothorac Surg 1998; 13: 541–545.
• Calafiore AM, Di Mauro M, Contini M, Di Giammarco G, Pano M, Vitolla G, Bivona A, Carella R, D’Alessandro S. Myocardial cardiopulmonary bypass in multivessel disease: Impact of the strategy on early outcome. Ann Thorac Surg 2001;72.456–463.
• Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomised controlled trials. Lancet 2002;359:1194–1199.