calca-protein--human and Coronary-Disease

This study investigated whether intraoperative use of a cell saver reduces the systemic inflammatory response after coronary operations using cardiopulmonary bypass (CPB).. The study randomized 29 patients, 15 to cell saving of pericardial suction blood and residual blood in the CPB circuit after perfusion (cell saver group) vs 14 who received direct retransfusion of the suction blood and the CPB circuit blood (control group). Outcome measures were plasma concentrations of the inflammatory markers interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-alpha, soluble tumor necrosis factor receptors I and II, and procalcitonin at 6, 24, and 72 hours postoperatively.. At 6 hours postoperatively, the cell saver group displayed significantly reduced plasma levels of IL-6 and IL-8 (p < 0.05). A reduction in IL-10 was also found (p = 0.05), along with nonsignificant reductions in the remaining markers. At 24 and 72 hours, significant differences between groups no longer existed. In the cell saver group, the suction blood and CPB circuit blood were cleared for tumor necrosis factor receptors (p < 0.005), and IL-6, IL-8, IL-10, and procalcitonin were significantly reduced (p < 0.05). Median intraoperative blood loss was 250 mL in the cell saver group vs 475 mL (p < 0.02). Immediately postoperatively the hemoglobin level was higher in the cell saver group (p < 0.03). Transfusion requirements were similar.. The cell saver reduced the systemic levels of the proinflammatory markers IL-6 and IL-8 at 6 hours after CPB. The role of the anti-inflammatory molecules IL-10 and soluble tumor necrosis factor receptors is undefined in this setting.

Topics: Aged; Blood Transfusion, Autologous; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Coronary Artery Bypass; Coronary Disease; Female; Follow-Up Studies; Humans; Inflammation Mediators; Interleukins; Intraoperative Care; Male; Middle Aged; Postoperative Complications; Probability; Prospective Studies; Protein Precursors; Reference Values; Risk Assessment; Statistics, Nonparametric; Survival Analysis; Survival Rate; Treatment Outcome; Tumor Necrosis Factor-alpha

Cardiac surgery using cardiopulmonary bypass (CPB) often induces a systemic inflammatory response syndrome (SIRS). The concept of minimally invasive direct coronary artery bypass (MIDCAB) eliminates cardiopulmonary bypass. We evaluated the perioperative time course of procalcitonin (PCT) to compare the inflammatory response due to these two different surgical procedures. 57 patients were studied: CABG with CPB (n = 30), MIDCAB without CPB (n = 27). The following data were measured preoperatively, after induction of anesthesia, after separation from CPB in the CABG group or after left internal mammary artery (LIMA)-to-left anterior descending artery (LAD) anastomosis in MIDCAB group, and every 3 hours for the first 42 hours in the ICU: PCT, C-reactive protein (CRP), body temperature, hemodynamic parameters, and the need for catecholamines. Leucocyte counts were measured daily. For statistical analyses the Friedmann, Wilcoxon, or Mann-Whitney U tests were used. PCT in the CABG group rose to a maximum of 2.0 ng/ml (median) at 15 hrs postoperatively. In the MIDCAB group maximal PCT concentration was 0.7ng/ml (median) (p < 0.05). CRP was elevated to 17.1 mg/dl in the CABG and 18.5mg/dl in the MIDCAB group (n.s.). The leucocyte counts were increased on day 2 in the CABG group (p < 0.05). In the CABG group about 25% of the patients needed noradrenaline, but in the MIDCAB group none (p < 0.05). Body temperature did not differ between both groups. The increase in PCT concentration was more pronounced after CABG, indicating a reduced inflammatory response after MIDCAB. CRP was increased after both procedures. PCT reflects the inflammatory response after cardiac bypass surgery with or without CPB.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Coronary Artery Bypass; Coronary Disease; Female; Glycoproteins; Humans; Inflammation; Male; Middle Aged; Minimally Invasive Surgical Procedures; Monitoring, Physiologic; Protein Precursors; Sensitivity and Specificity; Statistics, Nonparametric

Topics: Aged; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Coronary Disease; Female; Genetic Predisposition to Disease; Humans; Male; Middle Aged; Polymorphism, Single Nucleotide