The cytokine balance during CABG surgery with and without cardiopulmonary bypass

Background: We investigated the cytokine response during coronary artery bypass grafting (CABG) surgery with and without cardiopulmonary bypass (off-pump) and the effect on patient's outcome in the early postoperative period. Methods: Eighteen patients were studied, 9 patients undergoing off- pump surgery (group 1) and 9 patients with CPB (group 2). Demographic and preoperative characteristics were comparable in both groups. Plasma levels of TNF-alpha, IL- 6, IL- 8, IL- 10, IL- 4, tumour necrosis soluble receptors-1 (TNFsr-1) and tumour necrosis soluble receptors-2 (TNFsr-2) were measured before skin incision (T0), before revascularization (T1), after revascularization (T2), 2 h (T3) and 24 (T4) hours after skin closure. Levels of myocardial enzymes were also measured in the first postoperative morning. Results: Serum levels of TNF-a and IL- 8 increased in group 2 at T3 and T4 more than at T0 (p < 0.05). IL- 6 increased in both groups with higher levels in group 2 than in group 1 at T3 (773 +/- 331 vs 315 +/- 189 pg/ml; p < 0.05). IL- 10 was higher in group 2 than in group 1 at T2 (115 +/- 119 vs 13 +/- 4 pg/ml; p < 0.001) and at T3 (212 +/- 171 vs 31 +/- 29 pg/ml; p < 0.05). At T3 levels of TNFsr-1 and TNFsr-2 were higher in group 2 than in group 1 (TNFsr-1 4858 +/- 1325 vs 2089 +/- 584 pg/ ml; p < 0.01 and TNFsr-2 4971 +/- 63 vs 3801 +/- 738 pg/ ml; p < 0.05). Production of IL-4 did not increase in neither group. The length of ICU stay was less in group 1 than in group 2 (52 +/- 33 vs 26 +/- 11 h; p < 0.05) as well as was the length of hospital stay (7.1 +/- 0.4 vs 5.3 +/- 0.5 days; p < 0.001). Conclusion: Off-pump procedure evoked a lower cytokine response than CABG with CPB. This minimised myocardial damage and shorten the stay in the ICU and the hospital. (C) 2010 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V.