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Cardiovascular Research 2000 45(4):853-859; doi:10.1016/S0008-6363(99)00403-4
© 2000 by European Society of Cardiology
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Copyright © 2000, European Society of Cardiology

Peri-operative myocardial tissue injury and the release of inflammatory mediators in coronary artery bypass graft patients

Erik J Fransena,*, Jos G Maessena, Wim.Th Hermensb, Jan F.C Glatzb and Wim A Buurmanc

aDepartment of Cardiothoracic Surgery, University Hospital Maastricht, Maastricht, The Netherlands
bCardiovascular Research Institute Maastricht, Maastricht, The Netherlands
cDepartment of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands

* Corresponding author. Tel.: +31-43-387-7068; fax: +31-43-387-5075 efr{at}scpc.azm.nl

Objective: This study was conducted to evaluate to what extent the ischemia-reperfusion injury resulting from the cardiopulmonary bypass (CPB) and aortic cross-clamping procedures during coronary artery bypass grafting (CABG) contributes to the systemic inflammatory response generally found in these patients. Methods: Serum levels of enzymes (CK and CK-MB) and non-enzymatic proteins (FABP and myoglobin) as markers of myocardial tissue injury, bactericidal permeability increasing protein (BPI) as an indicator of neutrophil activation, interleukin-6 (IL-6) as inducer of the acute phase response and lipopolysaccharide binding protein (LBP) as parameter of the acute phase response were measured in 15 low-risk CABG patients with cardiopulmonary bypass (CPB), and 17 low-risk CABG patients without CPB. Results: Already 0.5 h after reperfusion significantly increased plasma levels of all markers of myocardial tissue injury were noted in patients having surgery with CPB, but not in non-CPB patients. No significant differences were found between both groups for BPI and IL-6 levels in the early reperfusion period. BPI and IL-6 levels were higher in the non-CPB group on the first post-operative day (P<0.05). However, no correlations were found for any marker of peri-operative tissue damage with either early neutrophil activation, or acute phase reactants. Conclusions: Perioperative myocardial injury resulting from CPB and aortic cross-clamping in low-risk CABG patients does not contribute to the release of inflammatory mediators in these patients.

KEYWORDS Cardiovascular surgery; Ischemia; Reperfusion; Enzyme (kinetics); Cytokines


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