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Makiabadi E, Nakhaeizadeh R, Soleimani M, Nasrollahzadeh J. Effects of perioperative vitamin E and zinc co-supplementation on systemic inflammation and length of stay following coronary artery bypass graft surgery: a randomized controlled trial. Eur J Clin Nutr 2024; 78:120-127. [PMID: 37891226 DOI: 10.1038/s41430-023-01356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES Coronary artery bypass graft (CABG) surgery has been reported to be associated with lower postoperative plasma antioxidant and zinc levels. We hypothesized that perioperative supplementation of vitamin E and zinc might improve short-term postoperative outcomes. METHODS In this placebo-controlled double-blind, randomized study, patients undergoing CABG performed with cardiopulmonary bypass were recruited. The intervention group received zinc and vitamin E supplementation (1200 IU vitamin E and 120 mg elemental zinc) the day before surgery, followed by postoperative daily supplementation of 30 mg zinc and 200 IU vitamin E from the 2nd day after surgery to 3 weeks. The control group received placebos. Length of stay (LOS) in the intensive care unit and hospital, sequential organ failure assessment score on 3rd day after surgery, and plasma inflammatory markers on days 3 and 21 post-surgery were evaluated. RESULTS Seventy-eight patients completed the study (40 in the intervention group and 38 in the placebo group). The hospital LOS was significantly shorter (p < 0.05) in the intervention group. Postoperative changes in plasma albumin levels were not different between the two groups. The plasma zinc level was higher (p < 0.0001), but plasma C-reactive protein (p = 0.01), pentraxin 3 (p < 0.0001), interferon γ (p < 0.05), malondialdehyde (p < 0.05), and aspartate aminotransferase (p < 0.01) were lower in the intervention group compared to the placebo group. CONCLUSIONS Perioperative vitamin E and zinc supplementation significantly reduced hospital LOS and the inflammatory response in CABG surgery patients. In these patients, the optimal combination and dose of micronutrients need further study but could include zinc and vitamin E. CLINICAL TRIAL REGISTRY This trial was registered at ClinicalTrials.gov website (NCT05402826).
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Affiliation(s)
- Elham Makiabadi
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, No. 7, Hafezi St., Farahzadi Blvd., Qods Town, Tehran, Iran
| | - Reza Nakhaeizadeh
- Department of Surgery, School of Medicine, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Soleimani
- Department of Cardiac Intensive Care Unit, School of Medicine, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Nasrollahzadeh
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, No. 7, Hafezi St., Farahzadi Blvd., Qods Town, Tehran, Iran.
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Laurikka A, Vuolteenaho K, Toikkanen V, Rinne T, Leppänen T, Hämäläinen M, Tarkka M, Laurikka J, Moilanen E. Inflammatory Glycoprotein YKL-40 Is Elevated after Coronary Artery Bypass Surgery and Correlates with Leukocyte Chemotaxis and Myocardial Injury, a Pilot Study. Cells 2022; 11:3378. [PMID: 36359773 PMCID: PMC9653903 DOI: 10.3390/cells11213378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 01/06/2024] Open
Abstract
The aim of the present study was to investigate the levels of YKL-40 during and after coronary artery bypass grafting surgery (CABG) and to establish possible connections between YKL-40 and markers of oxidative stress, inflammation, and myocardial injury. Patients undergoing elective CABG utilizing cardiopulmonary bypass (CPB) were recruited into the study. Blood samples were collected at the onset of anesthesia, during surgery and post-operatively. Levels of YKL-40, 8-isoprostane, interleukin-8 (IL-8), monocyte chemotactic protein-1 (MCP-1) and troponin T (TnT) were measured by immunoassay. YKL-40 levels increased significantly 24 h after CPB. Positive correlation was seen between post-operative TnT and YKL-40 levels (r = 0.457, p = 0.016) and, interestingly, baseline YKL-40 predicted post-operative TnT increase (r = 0.374, p = 0.050). There was also a clear association between YKL-40 and the chemotactic factors MCP-1 (r = 0.440, p = 0.028) and IL-8 (r = 0.484, p = 0.011) linking YKL-40 to cardiac inflammation and fibrosis following CABG. The present results show, for the first time, that YKL-40 is associated with myocardial injury and leukocyte-activating factors following coronary artery bypass surgery. YKL-40 may be a factor and/or biomarker of myocardial inflammation and injury and subsequent fibrosis following heart surgery.
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Affiliation(s)
- Antti Laurikka
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33014 Tampere, Finland
| | - Katriina Vuolteenaho
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33014 Tampere, Finland
| | - Vesa Toikkanen
- Tampere University Hospital Heart Center Co., P.O. Box 2000, 33521 Tampere, Finland
| | - Timo Rinne
- Tampere University Hospital Heart Center Co., P.O. Box 2000, 33521 Tampere, Finland
- Department of Anaesthesia, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
| | - Tiina Leppänen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33014 Tampere, Finland
| | - Mari Hämäläinen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33014 Tampere, Finland
| | - Matti Tarkka
- Tampere University Hospital Heart Center Co., P.O. Box 2000, 33521 Tampere, Finland
| | - Jari Laurikka
- Tampere University Hospital Heart Center Co., P.O. Box 2000, 33521 Tampere, Finland
- Finnish Cardiovascular Research Center Tampere, Tampere University, 33014 Tampere, Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, 33014 Tampere, Finland
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Naruka V, Salmasi MY, Arjomandi Rad A, Marczin N, Lazopoulos G, Moscarelli M, Casula R, Athanasiou T. Use of Cytokine Filters During Cardiopulmonary Bypass: Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1493-1503. [PMID: 36041987 DOI: 10.1016/j.hlc.2022.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/25/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac surgery involving cardiopulmonary bypass (CPB) activates an inflammatory response releasing cytokines that are associated with less favourable outcomes. This study aims to compare i) CPB during cardiac surgery (control) versus ii) CPB with haemoadsorption therapy; and assess the effect of adding this therapy in reducing the inflammatory cytokines burden. METHODS A systematic literature review with metanalysis was conducted regarding the main outcomes (operative mortality, ventilation duration, intensive care unit [ICU] and hospital stays) and day-1 inflammatory markers levels post-surgery. Fifteen (15) studies were included for final analysis (eight randomised controlled trials, seven observational studies) with no evidence of publication bias. RESULTS Subgroup analysis of non-elective surgeries across observational studies (emergency and infective endocarditis) significantly favoured cytokine filters in terms of 30-day mortality (OR 0.40, 95% CI 0.20, 0.83; p=0.01) and shorter ICU stay (MD -42.36, 95% CI -68.07, -16.65; p=0.001). At day-1 post-surgery, there was a significant difference favouring the cytokine filter group in c-reactive protein (CRP) (MD -0.71, 95% CI -0.84, -0.59; p<0.001) with no differences in white blood count (WBC), procalcitonin (PCT), tumour necrosis factor-alpha (TNF-α), IL-6, IL-8 and lactate. When comparing cytokine filters and control across all studies there was no significant difference in operative mortality, ventilation duration, hospital stay and ICU length of stay. Also, there were no statistical differences in randomised controlled trials (RCTs) using haemadsorption filters. CONCLUSIONS A significant reduction in 30-day mortality and ICU stay could be obtained by using haemadsorption therapy during non-elective cardiac surgery, especially emergency surgery and in patients with higher inflammatory burden such as infective endocarditis.
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Affiliation(s)
- Vinci Naruka
- Department of Surgery and Cancer, Imperial College, London, UK; Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | | | | | - Nandor Marczin
- Department of Surgery and Cancer, Imperial College, London, UK
| | - George Lazopoulos
- Department of Cardiothoracic Surgery, University Hospital of Heraklion, Crete, Greece
| | | | - Roberto Casula
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, London, UK; Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK.
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Haidari Z, Demircioglu E, Boss K, Tyczynski B, Thielmann M, Schmack B, Kribben A, Weymann A, El Gabry M, Ruhparwar A, Wendt D. Intraoperative hemoadsorption in high-risk patients with infective endocarditis. PLoS One 2022; 17:e0266820. [PMID: 35900987 PMCID: PMC9333242 DOI: 10.1371/journal.pone.0266820] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Postoperative sepsis is an important cause of morbidity and mortality in patients with infective endocarditis undergoing surgical therapy. Blood purification using hemoadsorption therapy shows promising results in the treatment of sepsis. In this study, the clinical effects of intraoperative hemoadsorption in high-risk patients with infective endocarditis were evaluated.
Methods
Eligible candidates were high-risk patients with infective endocarditis undergoing cardiac surgery between January 2014 and December 2019. Patients with intraoperative hemoadsorption (hemoadsorption) were compared to patients without hemoadsorption (control). The endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Additionally, postoperative vasopressor need, systemic vascular resistance indices and Sequential Organ Failure Assessment (SOFA) scores were compared.
Results
After propensity score matching, 70 high-risk patients were included. Postoperative sepsis occurred in 14 patients in the hemoadsorption group and in 16 patients in the control group, p = 0.629. Four patients died due to postoperative sepsis in the hemoadsorption group, while 11 postoperative septic patients died in the control group, p = 0.041. In-hospital mortality was 34% in the hemoadsorption group versus 43% in the control group, p = 0.461. On ICU-admission and the first postoperative day, the cumulative vasopressor need was 0.17 versus 0.25 μg/kgBW/min, p = 0.123 and 0.06 versus 0.11 μg/kgBW/min, p = 0.037, and the systemic vascular resistance index was 1448 versus 941 dyn·s·cm-5, p = 0.013 and 1156 versus 858 dyn·s·cm-5, p = 0.110 in the hemoadsorption versus control group, respectively. Postoperative course of SOFA score normalized significantly (p = 0.01) faster in the hemoadsorption group.
Conclusions
In high-risk cardiac surgical patients with infective endocarditis, intraoperative hemoadsorption significantly reduced sepsis-associated mortality. Furthermore, intraoperative hemoadsorption resulted in significant faster recovery of hemodynamics and organ function. Intraoperative hemoadsorption seems to attenuate the severity of postoperative sepsis.
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Affiliation(s)
- Zaki Haidari
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
- * E-mail:
| | - Ender Demircioglu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Kristina Boss
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | | | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
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Hildenborg M, Kåhlin J, Granath F, Schening A, Granström A, Ebberyd A, Klevenvall L, Zetterberg H, Han J, Schlegel TT, Harris R, Harris HE, Eriksson LI. The Neuroimmune Response to Surgery – An Exploratory Study of Trauma-Induced Changes in Innate Immunity and Heart Rate Variability. Front Immunol 2022; 13:911744. [PMID: 35874666 PMCID: PMC9301672 DOI: 10.3389/fimmu.2022.911744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Surgery triggers a systemic inflammatory response that ultimately impacts the brain and associates with long-term cognitive impairment. Adequate regulation of this immune surge is pivotal for a successful surgical recovery. We explored the temporal immune response in a surgical cohort and its associations with neuroimmune regulatory pathways and cognition, in keeping with the growing body of evidence pointing towards the brain as a regulator of peripheral inflammation. Brain-to-immune communication acts through cellular, humoral and neural pathways. In this context, the vagal nerve and the cholinergic anti-inflammatory pathway (CAP) have been shown to modify peripheral immune cell activity in both acute and chronic inflammatory conditions. However, the relevance of neuroimmune regulatory mechanisms following a surgical trauma is not yet elucidated. Twenty-five male patients undergoing elective laparoscopic abdominal surgery were included in this observational prospective study. Serial blood samples with extensive immune characterization, assessments of heart rate variability (HRV) and cognitive tests were performed before surgery and continuing up to 6 months post-surgery. Temporal immune responses revealed biphasic reaction patterns with most pronounced changes at 5 hours after skin incision and 14 days following surgery. Estimations of cardiac vagal nerve activity through HRV recordings revealed great individual variations depending on the pre-operative HRV baseline. A principal component analysis displayed distinct differences in systemic inflammatory biomarker trajectories primarily based on pre-operative HRV, with potiential consequences for long-term surgical outcomes. In conclusion, individual pre-operative HRV generates differential response patterns that associate with distinct inflammatory trajectories following surgery. Long-term surgical outcomes need to be examined further in larger studies with mixed gender cohorts.
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Affiliation(s)
- Malin Hildenborg
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Malin Hildenborg,
| | - Jessica Kåhlin
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Granath
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Department for Medicine Solna, Karolinska Institutet, Stockhlom, Sweden
| | - Anna Schening
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Granström
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Ebberyd
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Klevenvall
- Rheumatology Unit, Center for Molecular Medicine, Department for Medicine Solna, Karolinska Institutet, Stockhlom, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital of Gothenburg, Mölndal, Sweden
- Department of Molecular Neuroscience, University College London Institute of Neurology, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong SAR, China
| | - Jinming Han
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Todd T. Schlegel
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Nicollier-Schlegel SARL, Trélex, Switzerland
| | - Robert Harris
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Erlandsson Harris
- Rheumatology Unit, Center for Molecular Medicine, Department for Medicine Solna, Karolinska Institutet, Stockhlom, Sweden
| | - Lars I. Eriksson
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Silvetti S, Lembo R, Mesini A, Landoni G, Castagnola E, Nuri H, Pome G, Moscatelli A. Procalcitonin and Early Postoperative Infection After Pediatric Cardiopulmonary Bypass Surgery. J Cardiothorac Vasc Anesth 2021; 35:3688-3693. [PMID: 34127358 DOI: 10.1053/j.jvca.2021.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Systemic inflammation and bacterial infections are critical occurrences after pediatric cardiac surgery. Elevated white blood cell count and C-reactive protein cannot discriminate between these two conditions in the early postoperative period. The aim of this study was to understand whether procalcitonin (PCT) values within 48 hours of surgery could be a useful marker of postoperative infection. DESIGN Retrospective observational study. SETTING The study was performed in a teaching hospital. PARTICIPANTS All patients ≤six years of age. INTERVENTIONS Cardiac surgery on cardiopulmonary bypass from January 1, 2017 to January 1, 2020. MEASUREMENT AND MAIN RESULTS PCT, white blood cell count, and C-reactive protein values were measured at intensive care unit admission and at 24 and 48 hours after surgery. All positive cultures in the first seven days after surgery were recorded. Out of 177 consecutive patients, 22 (12%) developed infections. PCT at 48 hours after surgery was the only laboratory predictor of infections in the first seven days after surgery (p = 0.02). Receiver operating curve analyses on PCT values at 48 hours identified an optimal cut-off value of 1.85 ng/mL in the overall population. Area under the curve was 0.63, sensitivity 63%, and specificity 69%. CONCLUSIONS In light of this preliminary result, the clinical relevance and predictive accuracy of PCT are promising in patients with increasing values of PCT but need to be confirmed in a larger sample.
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Affiliation(s)
- Simona Silvetti
- Neonatal and Pediatric Intensive Care Unit, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Halkawt Nuri
- Cardiac Surgery Unit, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giuseppe Pome
- Cardiac Surgery Unit, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Rouatbi H, Farhat N, Heying R, Vazquez-Jimenez JF, Parent AS, Seghaye MC. Myocardial Expression of Estrogen Receptor-mRNA Is Associated With Lower Markers of Post-operative Organ Damage in Young Patients With Congenital Cardiac Defect. Front Pediatr 2021; 9:729198. [PMID: 34631625 PMCID: PMC8493930 DOI: 10.3389/fped.2021.729198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Estrogen receptors (ERs) relate to cardio-protection in adults, but their role in younger patients is not known. We aimed to assess the myocardial expression of ERα- and ERβ- mRNA in young patients with congenital cardiac disease and to analyze their putative protective role. Patients and Methods: Twenty children and young adults (seven females and 13 males) with a median age of 13.8 years (interquartile range: 12.3 years) were enrolled in this prospective study. The myocardial expression of ER-mRNA and genes involved in inflammation, growth, and stress response was assessed by real-time PCR and was correlated to post-operative (po) outcome. Results: ER-mRNA was detected in the myocardium of all patients, independently of gender and age. The expression of ER-mRNA correlated with that of mRNA coding for brain natriuretic peptide and for all cytokines tested. A higher ERα-mRNA expression correlated with lower troponin T concentrations at 24 h po (p = 0.032), higher PaO2/FiO2 ratio at 4 h po (p = 0.059), lower fluid retention at 4 h po (p = 0.048), and lower aspartate aminotransferase (AST) levels at 24 h po (p = 0.047). A higher ERβ-mRNA expression was also correlated with lower fluid retention at 24 h po (p = 0.048). Patients in whom the levels of ERα- and ERβ-mRNA were >P50 had lower troponin T (p = 0.003, respectively) and lower AST concentrations at 24 h po (p = 0.043, respectively) than the others. Conclusions: The expression of ERα- and ERβ-mRNA is present in the myocardium of children and young adults with congenital cardiac defect and is associated with lower markers of po organ damage. This suggests that ERs may provide perioperative organ protection in this population.
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Affiliation(s)
- Hatem Rouatbi
- Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Nesrine Farhat
- Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Jaime F Vazquez-Jimenez
- Department of Pediatric and Congenital Cardiac Surgery, University Hospital Aachen, Aachen, Germany
| | - Anne-Simone Parent
- Department of Pediatric Endocrinology, University Hospital Liège, Liège, Belgium
| | - Marie-Christine Seghaye
- Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium
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8
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Yang J, Ji D, Zhu YQ, Ren Y, Zhang X, Dai HY, Sun X, Zhou Y, Chen ZY, Li QG, Yao H. Hemoperfusion with HA380 in acute type A aortic dissection patients undergoing aortic arch operation (HPAO): a randomized, controlled, double-blind clinical trial. Trials 2020; 21:954. [PMID: 33228727 PMCID: PMC7684885 DOI: 10.1186/s13063-020-04858-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cardiopulmonary bypass (CPB) is an important cause of significant systemic inflammatory response syndrome (SIRS) in the surgical treatment of acute type A aortic dissection (ATAAD). In patients with arch vessel involvement, extensive surgical repairs often necessitate prolonged use of CPB and results in extensive inflammatory responses. Cytokines and chemokines released during CPB contribute to the progression of SIRS, increase perioperative complications, and negatively impact surgical outcomes. A cytokine adsorber (HA380) is expected to reduce the level of cytokines during CPB, which may decrease both intraoperative and postoperative inflammation. The purpose of this study is to investigate if HA380 is able to reduce the levels of inflammatory cytokines and decrease perioperative complications in ATAAD patients undergoing CPB and deep hypothermic circulatory arrest (DHCA). Methods This study is a single-center, randomized, controlled, double-blind clinical trial. The study aims to recruit 88 patients with ATAAD and aortic arch involvement who will undergo CPB and DHCA to repair the dissected aorta. Patients will be randomized equally into the CPB/DHCA only group (control group) and the CPB/DHCA + HA380 hemoperfusion group (intervention group), with 44 patients each. Patients in the control group will undergo CPB and DHCA only, while patients in the intervention group will undergo continuous hemoperfusion with HA380, in addition to CPB and DHCA. The primary outcome is a composite of major perioperative complications. The secondary outcomes include related inflammatory markers, coagulation parameters, and minor perioperative complications. To comprehensively evaluate the effect of hemoperfusion on the perioperative outcomes, we will also determine if there are differences in perioperative all-cause mortality, length of ICU stay, and total hospitalization costs. Discussion In the current trial, hemoperfusion will be applied in patients undergoing CPB and DHCA for repair of the aorta involving the aortic arch. This trial aims to test the safety and efficacy of our hemoperfusion device (HA380) in such settings. Upon completion of the trial, we will determine if HA380 is effective in reducing perioperative proinflammatory cytokine levels. Further, we will also verify if reduction in the proinflammatory cytokine levels, if present, translates to improvement in patient outcomes. Trial registration ClinicalTrials.gov NCT04007484. Registered on 1 July 2019 (retrospectively registered).
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Affiliation(s)
- Jing Yang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Dong Ji
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Yue-Qian Zhu
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Yun Ren
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Xun Zhang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Hong-Yu Dai
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Xu Sun
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Yi Zhou
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Zhi-Yuan Chen
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China
| | - Qing-Guo Li
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China.
| | - Hao Yao
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu Province, China.
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Fakhri D, Marwali EM, Budiwardhana N, Roebiono PS, Rahajoe AU, Caesario M. Diagnosing infection after infant open heart surgery: role of procalcitonin. Asian Cardiovasc Thorac Ann 2019; 27:641-645. [DOI: 10.1177/0218492319879529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Diagnosing infection in infants after cardiac surgery with cardiopulmonary bypass remains challenging. We aimed to determine whether procalcitonin discriminates post-cardiopulmonary bypass systemic inflammatory response syndrome from bacterial infection in infants better than C-reactive protein and leukocyte count. Method One hundred and eight infants underwent cardiac surgery with cardiopulmonary bypass. Leukocyte count, C-reactive protein, and procalcitonin were measured on arrival in the intensive care unit as baseline, and repeated on postoperative day 3. Bacterial infection was defined as proven infection with a positive blood or sputum culture. Results Twenty-four infants had proven bacterial infection. Baseline leukocyte counts and C-reactive protein levels did not differ significantly between the 2 groups. On postoperative day 3, C-reactive protein (62 vs. 38.5 mg·L−1, p = 0.01) and procalcitonin levels (6.58 vs. 0.41 ng·mL−1, p < 0.01) were higher in patients with bacterial infection. Leukocyte counts did not differ significantly between the two groups ( p = 0.94). The area under the receiver operating curve for leukocyte count, C-reactive protein, and procalcitonin was 0.49 ( p = 0.94), 0.67 ( p = 0.01), and 0.87 ( p < 0.0010), respectively. The optimal cutoff value of procalcitonin was 2.5 ng·mL−1 (sensitivity 75%, specificity 88%). Conclusion In infants undergoing cardiac surgery with cardiopulmonary bypass, procalcitonin discriminates bacterial infection from post-cardiopulmonary bypass systemic inflammatory response syndrome better than C-reactive protein and leukocyte count.
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Affiliation(s)
- Dicky Fakhri
- Pediatric and Congenital Heart Surgery Unit, Department of Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Eva Miranda Marwali
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Novik Budiwardhana
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Poppy Surwianti Roebiono
- Pediatric and Congenital Heart Disease Division, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Pediatric and Congenital Heart Disease Division, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Michael Caesario
- Pediatric and Congenital Heart Surgery Unit, Department of Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Affiliation(s)
- Katia Donadello
- Unit of Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy -
| | - Enrico Polati
- Unit of Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
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Rubino AS, Serraino GF, Marsico R, Ventura V, Foti D, Gulletta E, Renzulli A. Leukocyte Filtration Improves Pulmonary Function and Reduces the Need for Postoperative Non-Invasive Ventilation. Int J Artif Organs 2018. [DOI: 10.1177/039139881203500908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Antonino S. Rubino
- Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania - Italy
| | - Giuseppe F. Serraino
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
| | - Roberto Marsico
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
| | - Valeria Ventura
- Department of Experimental and Clinical Medicine, Pathology Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
| | - Daniela Foti
- Department of Experimental and Clinical Medicine, Pathology Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
| | - Elio Gulletta
- Department of Experimental and Clinical Medicine, Pathology Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
| | - Attilio Renzulli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
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An observational study examining the effects of a surgically induced inflammatory response on the distribution of morphine and its metabolites into cerebrospinal fluid. Can J Anaesth 2017; 64:1009-1022. [PMID: 28710563 DOI: 10.1007/s12630-017-0933-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/25/2017] [Accepted: 07/05/2017] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function. METHODS We conducted a prospective pharmacokinetic study of the plasma and CSF distribution of the P-glycoprotein (PGP) substrate morphine in 33 patients undergoing open thoracic (n = 18) or endovascular (n = 15) aortic aneurysm repair. Morphine was administered with induction of anesthesia and in the intensive care unit. Plasma and CSF concentrations of interleukin (IL)-6, morphine, M3G, M6G, and albumin were measured prior to surgery (baseline), during surgery, and postoperatively every six hours until removal of the CSF drain. The area under the curve (AUC) was determined for plasma and CSF IL-6, morphine, M3G, and M6G concentrations vs time. The primary endpoint measures were the correlations between the morphine, M6G, and M3G AUC CSF/plasma ratios and systemic inflammation as quantified by the time-normalized IL-6 exposure, which was calculated for each individual by dividing the total exposure (AUC) by time (t). A Bonferroni corrected P < 0.017 indicated a significant correlation. RESULTS Plasma and CSF IL-6 concentrations increased postoperatively. The median [interquartile range] IL-6 exposures were significantly higher in the open vs endovascular surgical group for plasma (105 [40-256] pg·mL-1 vs 29 [16-70] pg·mL-1, respectively; P = 0.013) and CSF (79 [26-133] pg·mL-1 vs 16 [9-80] pg·mL-1, respectively; P = 0.013). For the primary endpoint, the plasma IL-6 AUC/t did not correlate with the CSF accumulation of morphine (r = -0.009; P = 0.96) or M3G (r = 0.37; P = 0.04) when corrected for surgical procedure, age, and sex. There were insufficient data on CSF concentration to complete the primary analysis for M6G. CONCLUSION Morphine distribution into the CSF was not significantly altered in patients undergoing thoracic aortic aneurysm repair. This suggests that BBB PGP function may not be affected by the perioperative inflammatory response. TRIAL REGISTRATION www.clinicaltrials.gov , NCT 00878371. Registered 7 April 2009.
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Şenay H, Sıvacı R, Kokulu S, Koca B, Bakı ED, Ela Y. The Effect of Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Prone Position on Pulmonary Mechanics and Inflammatory Markers. Inflammation 2017; 39:1469-74. [PMID: 27221140 DOI: 10.1007/s10753-016-0379-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of this present study is to compare the effect of pressure-controlled ventilation and volume-controlled ventilation on pulmonary mechanics and inflammatory markers in prone position. The study included 41 patients undergoing to vertebrae surgery. The patients were randomized into two groups: Group 1 received volume-controlled ventilation, while group 2 received pressure-controlled ventilation. The demographic data, pulmonary mechanics, the inflammatory marker levels just after the induction of anesthetics, at the 6th and 12th hours, and gas analysis from arterial blood samples taken at the beginning and the 30th minute were recorded. The inflammatory marker levels increased in both groups, without any significant difference among groups. Peak inspiratory pressure level was higher in the volume-controlled ventilation group. This study revealed that there is no difference regarding inflammatory marker levels between volume- and pressure-controlled ventilation.
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Affiliation(s)
- Hasan Şenay
- Medical Faculty Department of Anesthesia and Reanimation, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Remziye Sıvacı
- Medical Faculty Department of Anesthesia and Reanimation, Afyon Kocatepe University, Afyonkarahisar, Turkey. .,Tıp Fakültesi, Anesteziyoloji ve Reanimasyon AD, Kocatepe Üniversitesi, İzmir Yolu 8. Km, Afyonkarahisar, Turkey.
| | - Serdar Kokulu
- Medical Faculty Department of Anesthesia and Reanimation, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Buğra Koca
- Medical Faculty Department of Medical Biochemistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Elif Doğan Bakı
- Medical Faculty Department of Anesthesia and Reanimation, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Yüksel Ela
- Medical Faculty Department of Anesthesia and Reanimation, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Fakhri D, Busro PW, Rahmat B, Purba S, Mukti AA, Caesario M, Christy K, Santoso A, Djauzi S. Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study. MEDICAL JOURNAL OF INDONESIA 2016. [DOI: 10.13181/mji.v25i3.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: Postsurgical sepsis is one of the main causes of the high mortality and morbidity after open congenital heart surgery in infants. This study aimed to evaluate the role of cardiopulmonary bypass duration, thymectomy, surgical complexity, and nutritional status on postsurgical sepsis after open congenital cardiac surgery in infants.Methods: A total of 40 patients <1 year of age with congenital heart disease, Aristotle Basic Score (ABS) ≥6 were followed for clinical and laboratory data before and after surgery until the occurrence of signs or symptoms of sepsis or until a maximum of 7 days after surgery. Bivariate analyses were performed. Variables with p≤0.200 were then included for logistic regression.Results: Duration of cardiopulmonary bypass ≥90 minutes was associated with 5.538 increased risk of postsurgical sepsis in comparison to those ≤90 minutes (80% vs 25%, RR=5.538, p=0.006). No association was observed between the incidence of postsurgical sepsis with poor nutritional status (86% vs 84%, RR=1.059, p=1.000), thymectomy (and 50% vs 76%, RR=0.481, p=0.157), and Aristotle Basic Score (p=0.870).Conclusion: Cardiopulmonary bypass time influences the incidence of sepsis infants undergoing open congenital cardiac surgery. Further studies are needed to elaborate a number of risk factors associated with the incidence of sepsis in this population.
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Rovai D, Giannessi D, Andreassi MG, Gentili C, Pingitore A, Glauber M, Gemignani A. Mind injuries after cardiac surgery. J Cardiovasc Med (Hagerstown) 2016; 16:844-51. [PMID: 24933202 DOI: 10.2459/jcm.0000000000000133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
After cardiac surgery, delirium, cognitive dysfunction, depression, or anxiety disorders frequently occur, and profoundly affect patients' prognosis and quality of life. This narrative review focuses on the main clinical presentations of cognitive and psychological problems ('mind injuries') that occur postoperatively in absence of ascertainable focal neurologic deficits, exploring their pathophysiological mechanisms and possible strategies for prevention and treatment. Postoperative cognitive dysfunction is a potentially devastating complication that can involve several mechanisms and several predisposing, intraoperative, and postoperative risk factors, which can result in or be associated to cerebral microvascular damage. Postoperative depression is influenced by genetic or psychosocial predisposing factors, by neuroendocrine activation, and by the release of several pro-inflammatory factors. The net effect of these changes is neuroinflammation. These complex biochemical alterations, along with an aspecific response to stressful life events, might target the function of several brain areas, which are thought to represent a trigger factor for the onset of depression.
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Affiliation(s)
- Daniele Rovai
- aCNR, Institute of Clinical Physiology bBiomedicine, CNR, Institute of Clinical Physiology cClinical Psychology, Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa dCardiothoracic Department, Fondazione Toscana G. Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
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Poyrazoğlu HH, Duman Z, Demir Ş, Avşar MK, Atalay A, Çiftçi B, Bayraktar İ, Tor F. Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery. Balkan Med J 2016; 33:158-63. [PMID: 27403384 DOI: 10.5152/balkanmedj.2016.16379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/20/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α) playing an active role in this process. AIMS This research was to investigate the effects of pre-operative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. STUDY DESIGN Controlled clinical study. METHODS This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL) level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF); at the 5(th) minute of cross-clamping (Per TNF); 2 hours after termination of cardiopulmonary bypass (Post TNF); and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF). RESULTS The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05). The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05). CONCLUSION There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect patients operated in cardiac surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier: TCTR20150930001).
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Affiliation(s)
- H Hakan Poyrazoğlu
- Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey
| | - Zeynel Duman
- Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey
| | | | - M Kemal Avşar
- Department of Cardiovascular Surgery, Medicana International Hospital, İstanbul, Turkey
| | - Atakan Atalay
- Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey
| | - Bahattin Çiftçi
- Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey
| | - İhsan Bayraktar
- Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey
| | - Funda Tor
- Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey
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Bernardi MH, Rinoesl H, Dragosits K, Ristl R, Hoffelner F, Opfermann P, Lamm C, Preißing F, Wiedemann D, Hiesmayr MJ, Spittler A. Effect of hemoadsorption during cardiopulmonary bypass surgery - a blinded, randomized, controlled pilot study using a novel adsorbent. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:96. [PMID: 27059056 PMCID: PMC4826492 DOI: 10.1186/s13054-016-1270-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/22/2016] [Indexed: 01/25/2023]
Abstract
Background Cardiopulmonary bypass (CPB) surgery initiates a systemic inflammatory response, which is associated with postoperative morbidity and mortality. Hemoadsorption (HA) of cytokines may suppress inflammatory responses and improve outcomes. We tested a new sorbent used for HA (CytoSorb™; CytoSorbents Europe GmbH, Berlin, Germany) installed in the CPB circuit on changes of pro- and anti-inflammatory cytokines levels, inflammation markers, and differences in patients’ perioperative course. Methods In this first pilot trial, 37 blinded patients were undergoing elective CPB surgery at the Medical University of Vienna and were randomly assigned to HA (n = 19) or control group (n = 18). The primary outcome was differences of cytokine levels (IL-1β, IL-6, IL-18, TNF-α, and IL-10) within the first five postoperative days. We also analyzed whether we can observe any differences in ex vivo lipopolysaccharide (LPS)-induced TNF-α production, a reduction of high-mobility box group 1 (HMGB1), or other inflammatory markers. Additionally, measurements for fluid components, blood products, catecholamine treatment, bioelectrical impedance analysis (BIA), and 30-day mortality were analyzed. Results We did not find differences in our primary outcome immediately following the HA treatment, although we observed differences for IL-10 24 hours after CPB (HA: median 0.3, interquartile range (IQR) 0–4.5; control: not traceable, P = 0.0347) and 48 hours after CPB (median 0, IQR 0–1.2 versus not traceable, P = 0.0185). We did not find any differences for IL-6 between both groups, and other cytokines were rarely expressed. We found differences in pretreatment levels of HMGB1 (HA: median 0, IQR 0–28.1; control: median 48.6, IQR 12.7–597.3, P = 0.02083) but no significant changes to post-treatment levels. No differences in inflammatory markers, fluid administration, blood substitution, catecholamines, BIA, or 30-day mortality were found. Conclusions We did not find any reduction of the pro-inflammatory response in our patients and therefore no changes in their perioperative course. However, IL-10 showed a longer-lasting anti-inflammatory effect. The clinical impact of prolonged IL-10 needs further evaluation. We also observed strong inter-individual differences in cytokine levels; therefore, patients with an exaggerated inflammatory response to CPB need to be identified. The implementation of HA during CPB was feasible. Trial registration ClinicalTrials.gov: NCT01879176, registration date: June 7, 2013.
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Affiliation(s)
- Martin H Bernardi
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Harald Rinoesl
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Klaus Dragosits
- Department of Surgery, Research Laboratories, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria
| | - Robin Ristl
- Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
| | - Friedrich Hoffelner
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Philipp Opfermann
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Christian Lamm
- Department of Surgery, Research Laboratories, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria
| | - Falk Preißing
- Department of Surgery, Research Laboratories, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Michael J Hiesmayr
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Andreas Spittler
- Department of Surgery, Research Laboratories, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.,Core Facilities, Core Facility Flow Cytometry, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
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Fakhri D, Djauzi S, Murni TW, Rachmat J, Harahap AR, Rahayuningsih SE, Mansyur M, Santoso A. Genetic polymorphism in postoperative sepsis after open heart surgery in infants. Asian Cardiovasc Thorac Ann 2016; 24:326-31. [DOI: 10.1177/0218492316640128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Sepsis is one of the complications following open heart surgery. Toll-like receptor 2 and toll-interacting protein polymorphism influence the immune response after open heart surgery. This study aimed to assess the genetic distribution of toll-like receptor 2 N199N and toll-interacting protein rs5743867 polymorphism in the development of postoperative sepsis. Methods A prospective cohort study was conducted in 108 children <1-year old who underwent open heart surgery with a Basic Aristotle score ≥6. Patients with an accompanying congenital anomaly, human immunodeficiency virus infection, or history of previous open heart surgery were excluded. The patients’ nutritional status and genetic polymorphism were assessed prior to surgery. The results of genetic polymorphism were obtained through genotyping. Patients’ ages on the day of surgery and cardiopulmonary bypass times were recorded. The diagnosis of sepsis was established according to Surviving Sepsis Campaign criteria. Results Postoperative sepsis was observed in 21% of patients. There were 92.6% patients with toll-like receptor 2 N199N polymorphism and 52.8% with toll-interacting protein rs5743867 polymorphism. Conclusions Toll-like receptor 2 N199N polymorphism tends to increase the risk of sepsis (odds ratio = 1.974; 95% confidence interval: 0.23–16.92; p = 0.504), while toll-interacting protein rs5743867 polymorphism tends to decrease the risk of sepsis (odds ratio = 0.496; 95% confidence interval: 0.19–1.27; p = 0.139) in infants <1-year old undergoing complex open heart surgery.
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Affiliation(s)
- Dicky Fakhri
- Pediatric and Congenital Heart Surgery Unit, Department of Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Samsuridjal Djauzi
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tri Wahyu Murni
- Cardiothoracic Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Jusuf Rachmat
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Alida Roswita Harahap
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sri Endah Rahayuningsih
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anwar Santoso
- Research and Development Division, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Baumann A, Buchwald D, Annecke T, Hellmich M, Zahn PK, Hohn A. RECCAS - REmoval of Cytokines during CArdiac Surgery: study protocol for a randomised controlled trial. Trials 2016; 17:137. [PMID: 26971164 PMCID: PMC4789286 DOI: 10.1186/s13063-016-1265-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background On-pump cardiac surgery triggers a significant postoperative systemic inflammatory response, sometimes resulting in multiple-organ dysfunction associated with poor clinical outcome. Extracorporeal cytokine elimination with a novel haemoadsorption (HA) device (CytoSorb®) promises to attenuate inflammatory response. This study primarily assesses the efficacy of intraoperative HA during cardiopulmonary bypass (CPB) to reduce the proinflammatory cytokine burden during and after on-pump cardiac surgery, and secondarily, we aim to evaluate effects on postoperative organ dysfunction and outcomes in patients at high risk. Methods/design This will be a single-centre randomised, two-arm, patient-blinded trial of intraoperative HA in patients undergoing on-pump cardiac surgery. Subjects will be allocated to receive either CPB with intraoperative HA or standard CPB without HA. The primary outcome is the difference in mean interleukin 6 (IL-6) serum levels between the two study groups on admission to the intensive care unit. A total number of 40 subjects was calculated as necessary to detect a clinically relevant 30 % reduction in postoperative IL-6 levels. Secondary objectives evaluate effects of HA on markers of inflammation up to 48 hours postoperatively, damage to the endothelial glycocalyx and effects on clinical scores and parameters of postoperative organ dysfunction and outcomes. Discussion In this pilot trial we try to assess whether intraoperative HA with CytoSorb® can relevantly reduce postoperative IL-6 levels in patients undergoing on-pump cardiac surgery. Differences in secondary outcome variables between the study groups may give rise to further studies and may lead to a better understanding of the mechanisms of haemoadsorption. Trial registration German Clinical Trials Register number DRKS00007928 (Date of registration 3 Aug 2015)
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Affiliation(s)
- Andreas Baumann
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, Bochum, 44789, Germany
| | - Dirk Buchwald
- Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thorsten Annecke
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, Bochum, 44789, Germany
| | - Andreas Hohn
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, Bochum, 44789, Germany. .,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Monocyte hyporesponsiveness and Toll-like receptor expression profiles in coronary artery bypass grafting and its clinical implications for postoperative inflammatory response and pneumonia. Eur J Anaesthesiol 2015; 32:177-88. [DOI: 10.1097/eja.0000000000000184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kramer PA, Chacko BK, Ravi S, Johnson MS, Mitchell T, Barnes S, Arabshahi A, Dell’Italia LJ, George DJ, Steele C, George JF, Darley-Usmar VM, Melby SJ. Hemoglobin-associated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients. J Transl Med 2015; 95:132-41. [PMID: 25437645 PMCID: PMC4422823 DOI: 10.1038/labinvest.2014.144] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/09/2014] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis and valvular heart disease often require treatment with corrective surgery to prevent future myocardial infarction, ischemic heart disease, and heart failure. Mechanisms underlying the development of the associated complications of surgery are multifactorial and have been linked to inflammation and oxidative stress, classically as measured in the blood or plasma of patients. Postoperative pericardial fluid (PO-PCF) has not been investigated in depth with respect to the potential to induce oxidative stress. This is important because cardiac surgery disrupts the integrity of the pericardial membrane surrounding the heart and causes significant alterations in the composition of the pericardial fluid (PCF). This includes contamination with hemolyzed blood and high concentrations of oxidized hemoglobin, which suggests that cardiac surgery results in oxidative stress within the pericardial space. Accordingly, we tested the hypothesis that PO-PCF is highly pro-oxidant and that the potential interaction between inflammatory cell-derived hydrogen peroxide with hemoglobin is associated with oxidative stress. Blood and PCF were collected from 31 patients at the time of surgery and postoperatively from 4 to 48 h after coronary artery bypass grafting, valve replacement, or valve repair (mitral or aortic). PO-PCF contained high concentrations of neutrophils and monocytes, which are capable of generating elevated amounts of superoxide and hydrogen peroxide through the oxidative burst. In addition, PO-PCF primed naive neutrophils resulting in an enhanced oxidative burst upon stimulation. The PO-PCF also contained increased concentrations of cell-free oxidized hemoglobin that was associated with elevated levels of F2α isoprostanes and prostaglandins, consistent with both oxidative stress and activation of cyclooxygenase. Lastly, protein analysis of the PO-PCF revealed evidence of protein thiol oxidation and protein carbonylation. We conclude that PO-PCF is highly pro-oxidant and speculate that it may contribute to the risk of postoperative complications.
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Affiliation(s)
- Philip A. Kramer
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Balu K. Chacko
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Saranya Ravi
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Michelle S. Johnson
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Tanecia Mitchell
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Stephen Barnes
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Targeted Metabolomics and Proteomics Laboratory, Department of Pharmacology and Toxicology, University of Alabama at Birmingham, AL 35294
| | - Alireza Arabshahi
- Targeted Metabolomics and Proteomics Laboratory, Department of Pharmacology and Toxicology, University of Alabama at Birmingham, AL 35294
| | - Louis J. Dell’Italia
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Heart Failure Research, Division of Cardiovascular Sciences, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294,Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - David J. George
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Chad Steele
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - James F. George
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Victor M. Darley-Usmar
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Spencer J. Melby
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294,Corresponding author.
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Holmannova D, Kolackova M, Mandak J, Kunes P, Holubcova Z, Krejsek J, Vlaskova D, Andrys C. Inhibitory CD200R and proapoptotic CD95/CD95L molecules on innate immunity cells are modulated by cardiac surgery. Perfusion 2014; 30:543-55. [DOI: 10.1177/0267659114558286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Cardiac surgery directly initiates a systemic inflammatory response with the activation of both cellular and humoral parts of the immune system. Exaggerated immune system activation is associated with a risk of life-threatening multi-organ dysfunction (MOD) and increased morbidity and mortality in the postoperative period. The immune system response is regulated and terminated by inhibitory mechanisms, including the regulatory membrane molecules, such as CD200R, CD95, CD95L and soluble sCD200R. Methods: We measured the expression of CD95, CD95L, CD200R and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). Samples collected before surgery, after surgery and in the postoperative period were analyzed by flow cytometry and ELISA. Results: We found a significant increase in the percentage of granulocytes featuring the anti-inflammatory molecule CD200R (from 5% to 17.8%) after surgery. We presume that these cells were less susceptible to apoptosis because they rarely expressed CD95 as the CD200R+CD95– granulocyte sub-population prevailed. Only a small percentage of CD200R+ granulocytes expressed simultaneously CD95 (from 0.5 to 2.06 %). This small population of CD200R+CD95+ cells decreased expression of CD200R after surgery and, thus, was likely to be a source of increased sCD200R in serum (from 96 to 294 ng/mL). Also, the expression of CD95L on CD200R+ granulocytes and CD95 on CD200R+ monocytes was affected by surgery. The percentage of CD200R+ monocytes was elevated on the 1st postoperative day (from 30.6 to 49.4 %) and dropped below the preoperative value on the 7th day after surgery (from 30.6 to 19.8 %). This population comprised mainly CD200R+CD95+ monocytes in which the enhanced expression of CD95 was found. Conclusion: Our data show that the expression of CD200R, CD95 and CD95L was influenced by cardiac surgery and imply the role of these membrane molecules in cell regulation–inhibition and apoptosis following cardiac surgery.
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Affiliation(s)
- D Holmannova
- Department of Clinical Immunology, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - M Kolackova
- Department of Clinical Immunology, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - J Mandak
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - P Kunes
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Z Holubcova
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - J Krejsek
- Department of Clinical Immunology, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - D Vlaskova
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - C Andrys
- Department of Clinical Immunology, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
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Li YP, Huang J, Huang SG, Xu YG, Xu YY, Liao JY, Feng X, Zhang XG, Wang JH, Wang J. The compromised inflammatory response to bacterial components after pediatric cardiac surgery is associated with cardiopulmonary bypass–suppressed Toll-like receptor signal transduction pathways. J Crit Care 2014; 29:312.e7-13. [DOI: 10.1016/j.jcrc.2013.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/20/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
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Gunes T, Bozok S, Kestelli M, Yurekli I, Ilhan G, Ozpak B, Bademci M, Ozcem B, Sahin A. α-tocopherol and ascorbic acid in early postoperative period of cardiopulmonary bypass. J Cardiovasc Med (Hagerstown) 2013; 13:691-9. [PMID: 22885531 DOI: 10.2459/jcm.0b013e328356a2dc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To investigate whether α-tocopherol and ascorbic acid have effect on the suppression of inflammation in the early postoperative period after open heart surgery. METHODS A total of 59 patients who had undergone cardiopulmonary bypass (CPB) in the Cardiovascular Surgery Department of a tertiary center between June 2008 and December 2008 were retrospectively investigated. The study group consisted of 34 patients (25 men, 9 women) to whom ascorbic acid (500 mg/day) and α-tocopherol (300 mg/day) were administered on the day of operation (0th day) and the first four consecutive postoperative days. In contrast, 25 controls (20 men, 5 women) received no additional anti-inflammatory medications. The two groups were compared in terms of demographics, blood parameters such as C-reactive protein (CRP) and white blood cell (WBC) count, and durations of cross-clamp and CPB. RESULTS In the control group, CRP levels were found to be increased on the first postoperative day (P < 0.001) and CRP levels were correlated with triglyceride levels on the day of operation (P = 0.009) and the first postoperative day (P = 0.021). On the second postoperative day WBC count was found to be decreased (P = 0.008) and correlated with glucose level (P < 0.005). In the study group, CRP levels were found to be inversely correlated with serum high-density lipoprotein (HDL) (P = 0.049) on the first postoperative day and directly correlated with triglyceride levels on the second postoperative day (P = 0.017). Blood glucose levels were found to be increased on the first postoperative day (P = 0.021) and a correlation was detected between WBC count on the fourth postoperative day and doses of ascorbic acid and α-tocopherol (P = 0.027). CONCLUSION Suppression of the systemic inflammatory response to CPB is a double-edged sword and whether this suppression aids in the attenuation of morbidity and mortality is obscure. In this respect, ascorbic acid and α-tocopherol seem to display some anti-inflammatory effect, but further studies are necessary to reveal the actual therapeutic potential and the complex mechanism related to biochemical and inflammatory parameters.
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Affiliation(s)
- Tevfik Gunes
- Department of Cardiovascular Surgery, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
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Kubicki R, Grohmann J, Siepe M, Benk C, Humburger F, Rensing-Ehl A, Stiller B. Early prediction of capillary leak syndrome in infants after cardiopulmonary bypass†. Eur J Cardiothorac Surg 2013; 44:275-81. [DOI: 10.1093/ejcts/ezt028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Karu I, Tähepõld P, Ruusalepp A, Zilmer K, Zilmer M, Starkopf J. Effects of 60 minutes of hyperoxia followed by normoxia before coronary artery bypass grafting on the inflammatory response profile and myocardial injury. J Negat Results Biomed 2012; 11:14. [PMID: 22978419 PMCID: PMC3460785 DOI: 10.1186/1477-5751-11-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/11/2012] [Indexed: 11/27/2022] Open
Abstract
Background Ischemic preconditioning induces tolerance against ischemia-reperfusion injury prior a sustained ischemic insult. In experimental studies, exposure to hyperoxia for a limited time before ischemia induces a low-grade systemic oxidative stress and evokes an (ischemic) preconditioning-like effect of the myocardium. We hypothesised that pre-treatment by hyperoxia favours enchanced myocardial protection described by decreased release of cTn T in the 1st postoperative morning and reduces the release of inflammatory cytokines. Methods Forty patients with stable coronary artery disease underwent coronary artery bypass grafting with cardiopulmonary bypass. They were ventilated with 40 or >96% oxygen for 60 minutes followed by by 33 (18–59) min normoxia before cardioplegia. Results In the 1st postoperative morning concentrations of cTnT did not differ between groups ((0.44 (0.26-0.55) ng/mL in control and 0.45 (0.37-0.71) ng/mL in hyperoxia group). Sixty minutes after declamping the aorta, ratios of IL-10/IL-6 (0.73 in controls and 1.47 in hyperoxia, p = 0.03) and IL-10/TNF-α (2.91 and 8.81, resp., p = 0.015) were significantly drifted towards anti-inflammatory, whereas interleukins 6, 8and TNF-α and interferon-γ showed marked postoperative rise, but no intergroup differences were found. Conclusions Pre-treatment by 60 minutes of hyperoxia did not reduce postoperative leak of cTn T in patients undergoing coronary artery bypass surgery. In the hyperoxia group higher release of anti-inflammatory IL-10 caused drifting of IL-10/IL-6 and IL-10/TNF-α towards anti-inflammatory.
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Affiliation(s)
- Inga Karu
- North Estonia Medical Centre, Clinic of Anaesthesiology, Tallinn, Estonia.
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STAT3 regulates monocyte TNF-alpha production in systemic inflammation caused by cardiac surgery with cardiopulmonary bypass. PLoS One 2012; 7:e35070. [PMID: 22506067 PMCID: PMC3323636 DOI: 10.1371/journal.pone.0035070] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 03/13/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) surgery initiates a controlled systemic inflammatory response characterized by a cytokine storm, monocytosis and transient monocyte activation. However, the responsiveness of monocytes to Toll-like receptor (TLR)-mediated activation decreases throughout the postoperative course. The purpose of this study was to identify the major signaling pathway involved in plasma-mediated inhibition of LPS-induced tumor necrosis factor (TNF)-α production by monocytes. METHODOLOGY/PRINCIPAL FINDINGS Pediatric patients that underwent CPB-assisted surgical correction of simple congenital heart defects were enrolled (n = 38). Peripheral blood mononuclear cells (PBMC) and plasma samples were isolated at consecutive time points. Patient plasma samples were added back to monocytes obtained pre-operatively for ex vivo LPS stimulations and TNF-α and IL-6 production was measured by flow cytometry. LPS-induced p38 mitogen-activated protein kinase (MAPK) and nuclear factor (NF)-κB activation by patient plasma was assessed by Western blotting. A cell-permeable peptide inhibitor was used to block STAT3 signaling. We found that plasma samples obtained 4 h after surgery, regardless of pre-operative dexamethasone treatment, potently inhibited LPS-induced TNF-α but not IL-6 synthesis by monocytes. This was not associated with attenuation of p38 MAPK activation or IκB-α degradation. However, abrogation of the IL-10/STAT3 pathway restored LPS-induced TNF-α production in the presence of suppressive patient plasma. CONCLUSIONS/SIGNIFICANCE Our findings suggest that STAT3 signaling plays a crucial role in the downregulation of TNF-α synthesis by human monocytes in the course of systemic inflammation in vivo. Thus, STAT3 might be a potential molecular target for pharmacological intervention in clinical syndromes characterized by systemic inflammation.
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Pillai PS, Leeson S, Porter TF, Owens CD, Kim JM, Conte MS, Serhan CN, Gelman S. Chemical mediators of inflammation and resolution in post-operative abdominal aortic aneurysm patients. Inflammation 2012; 35:98-113. [PMID: 21286796 PMCID: PMC3123666 DOI: 10.1007/s10753-011-9294-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Temporal-metabolomic studies of local mediators during inflammation and its resolution uncovered novel pathways and mediators, e.g., lipoxins, resolvins, and protectins that stimulate key resolution responses. Since these studies were carried out with isolated human cells and in animal models, it is important to determine in humans whether temporal profiles between pro-inflammatory mediators and pro-resolving mediators are demonstrable in vivo. To this end, we examined patients undergoing abdominal aortic aneurysm (AAA) surgery. Profiles of mediators including eicosanoids were assessed in addition to pro-resolving mediators. The results demonstrate temporal relationships for local-acting peptides (e.g., VEGF, IL-10, TGF(β)) and lipid mediators (leukotrienes and resolvins). In addition, profiles obtained for AAA patients divided into two groups based on their temporal profile: one group consistent with a pro-inflammatory and another with a resolving profile. Together, these translational metabolomic profiles demonstrate for the first time the temporal relationships between local mediators in humans relevant in inflammation resolution.
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Affiliation(s)
- Padmini S. Pillai
- Center for Experimental Therapeutics and Reperfusion Injury, Harvard Institutes of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Stanley Leeson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Timothy F. Porter
- Center for Experimental Therapeutics and Reperfusion Injury, Harvard Institutes of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Christopher D. Owens
- Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Ji Min Kim
- Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Michael S. Conte
- Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Charles N. Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Harvard Institutes of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Director, Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Harvard Institutes of Medicine, Room 829, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Simon Gelman
- Center for Experimental Therapeutics and Reperfusion Injury, Harvard Institutes of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Impact of Endothelial Activation on Infective and Inflammatory Complications after Cardiac Surgery in type II Diabetes Mellitus. Int J Artif Organs 2011; 34:469-80. [DOI: 10.5301/ijao.2011.8329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2011] [Indexed: 11/20/2022]
Abstract
Purpose Altered endothelial response has been described in diabetics after cardiac surgery. Infections and inflammatory organ damage often complicate the postoperative course. We evaluated endothelial/cytokine response (ECR) after cardiac surgery and its role on infective/inflammatory complications of type II diabetic patients. Methods Perioperative ECR of 60 diabetic patients (Group A) undergoing cardiopulmonary bypass was compared to that of 60 non-diabetics (Group B). Hemodynamics, endothelial markers [vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1)], pro-inflammatory (IL-2, IL-6, IL-8) and anti-inflammatory cytokines (IL-10) were analyzed preoperatively (T0), at time of aortic declamping (T1), at ITU admission (T2), at 12 h (T3) and 24 h (T4) postoperatively. Postoperative infective/inflammatory complications were registered, and the related ECR was analyzed. Results Hemodynamics were comparable. No differences were found in perioperative IL-6 (p=0.776) and IL-8 (p=0.660) between the 2 groups. However, the diabetics showed significantly higher endothelial activation (VEGF p=0.0001, p=0.0001 since T1 to T3; MCP-1 p=0.0001, p<0.007 at T1, T3 and T4) with lower IL-10 (p=0.0001, p<0.05 at T2, T3, T4) and lower IL-2 secretion (p=0.0001, p<0.0001 at T1, T2). Infections developed in 23.3% of the diabetics; inflammatory complications in 13.3%. Those developing infections showed significantly lower IL-2 (p=0.042; p ≤. 021 at T1 and T2) than patients without infections, whereas those with complicated inflammatory lung or renal injury had higher MCP-1 leakage (p=0.006) with lower IL-10 (p=0.005). Conclusions The diabetics showed higher endothelial activation and lower antiinflammatory response to CPB compared to non-diabetics. Infections in diabetic patients correlated with depressed IL-2, while inflammatory complications correlated to higher endothelial activation and lower anti-inflammatory cytokine secretion.
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Preoperative statins improve recovery of renal function but not by an anti-inflammatory effect: observational study in 69 elderly patients undergoing cardiac surgery. Int Urol Nephrol 2011; 43:601-9. [DOI: 10.1007/s11255-011-9956-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 03/29/2011] [Indexed: 02/04/2023]
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Kunes P, Mandak J, Harrer J, Kolackova M, Andrys C, Holicka M, Krejsek J. Up-regulation of the Apo/Fas (CD95) complex on neutrophils harvested during cardiac surgery: distinct findings in patients operated on with or without the use of cardiopulmonary bypass. Perfusion 2010; 25:41-6. [DOI: 10.1177/0267659110363318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims: In a group of patients undergoing cardiac surgery performed both with (“on-pump”) and without the use (“offpump”) of cardiopulmonary bypass (CPB), we studied the changes of neutrophil membrane apoptosis-inducing complex Apo/Fas. Methods: Expression of Apo/Fas (CD95) on leukocytes was evaluated by flow cytometry. Results: In “on-pump” patients, we found an increase in the expression of CD95 median intensity fluorescence (MFI) on granulocytes from a baseline level median=56, (Q 1=45.5, Q3=64) to a median=88, (Q1=62, Q 3=109.5; p<0.01) at the 3rd postoperative day and median=74, (Q1=63, Q3=84.5; p<0.01) at the 7th postoperative day. In “off-pump” patients, granulocyte CD95 MFI was median=55, (Q1=51, Q3=84) before surgery. The significant increase was found on the 3rd postoperative day only; median=90, (Q 1=66; Q3=98; p<0.05). A similar pattern in the CD95 expression was also found if percentage changes of granulocyte CD95 MFI were followed. Moreover, the significantly increased Apo/Fas expression expressed as a percentage change of CD95 MFI was found in “on-pump” patients compared to “off-pump” patients, both at the 3rd postoperative day (p<0.05) and at the 7th postoperative day (p<0.01). Conclusions: This is the first direct evidence of increasing densities of the Apo/Fas complex on neutrophils in cardiac surgical patients.
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Affiliation(s)
- Pavel Kunes
- Department of Cardiac Surgery, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic, Department of Clinical Immunology and Allergology, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Mandak
- Department of Cardiac Surgery, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Harrer
- Department of Cardiac Surgery, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martina Kolackova
- Department of Clinical Immunology and Allergology, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ctirad Andrys
- Department of Clinical Immunology and Allergology, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Monika Holicka
- Department of Clinical Immunology and Allergology, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Krejsek
- Department of Clinical Immunology and Allergology, Charles University in Prague, University Hospital and Medical Faculty in Hradec Kralove, Hradec Kralove, Czech Republic, ,
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Franke A, Lante W, Franke A, Lante W, Kurig E, Zoeller LG, Kollig E, Markewitz A. Postoperative PMBC-derived IL-6 and TNF-alpha-release is uninfluenced by IL-12-mediated restoration of IFN-gamma synthesis. SCAND CARDIOVASC J 2009; 43:136-44. [DOI: 10.1080/14017430802409699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Onorati F, Santarpino G, Tangredi G, Palmieri G, Rubino AS, Foti D, Gulletta E, Renzulli A. Intra-aortic balloon pump induced pulsatile perfusion reduces endothelial activation and inflammatory response following cardiopulmonary bypass. Eur J Cardiothorac Surg 2009; 35:1012-9; discussion 1019. [DOI: 10.1016/j.ejcts.2008.12.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 11/17/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022] Open
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Engel J, Pitz S, Mühling J, Menges T, Martens F, Kwapisz M, Hempelmann G. Role of glutamine administration on T-cell derived inflammatory response after cardiopulmonary bypass. Clin Nutr 2009; 28:15-20. [DOI: 10.1016/j.clnu.2008.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 08/05/2008] [Accepted: 08/15/2008] [Indexed: 11/26/2022]
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Krejsek J, Kunes P, Kolackova M, Kudlova M, Lonsky V, Mandak J, Andrys C. Expression of Toll-like receptors 2 and 4 on innate immunity cells modulated by cardiac surgical operation. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 68:749-58. [PMID: 19061090 DOI: 10.1080/00365510802233434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to follow-up on the changes in the expression of Toll-like receptors (TLRs) on monocytes and granulocytes in venous blood of patients undergoing cardiac surgical operation. MATERIAL AND METHODS TLR2 and TLR4 expression on blood cells was determined by flow cytometry in 40 patients undergoing cardiac surgery performed either with cardiopulmonary bypass (CPB) ("on-pump") or without it ("off-pump"). RESULTS Intensity of the expression of TLR2 on both monocytes and granulocytes, expressed as median fluorescence intensity, is significantly reduced during CPB, being lower in both groups at the finish of surgery. These changes are not so remarkable in the case of TLR4 expression. Compared to "on-pump" patients, there is a higher relative number of TLR2(+) granulocytes in "off-pump" patients at the finish of surgery and of TLR4(+) granulocytes on the first postoperative day. CONCLUSIONS We found characteristic patterns in the expression of TLR2 and TLR4 on monocytes and granulocytes in venous blood of patients undergoing cardiac surgery with or without CPB.
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Affiliation(s)
- Jan Krejsek
- Department of Clinical Immunology and Allergology, Faculty of Medicine, Charles University in Prague, University Hospital in Hradec Kralove, Czech Republic.
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Franke A, Lante W, Kollig E, Markewitz A. A comparison of monocyte counts and ex vivo and in vitro monocyte cytokine production after major surgical trauma. J Surg Res 2008; 154:91-8. [PMID: 18952234 DOI: 10.1016/j.jss.2008.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 04/30/2008] [Accepted: 06/03/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Impaired function of cluster of differentiation 14-positive (CD14+) monocytes (MOs) after major surgical trauma is believed to predispose to infectious complications. Postoperative decreases in human leukocyte antigen (HLA)-DR expression, tumor necrosis factor-alpha (TNF-alpha) production and interleukin (IL)-12 synthesis have been reported. There are no studies comparing absolute MO counts and MO cytokine synthesis in peripheral blood and stimulated cultures. METHODS The study group included 10 low-risk patients undergoing elective cardiac surgery with extracorporeal circulation. Preoperatively (d0) and on the first (d1) and third (d3) postoperative d, we analyzed leukocyte counts, CD14+ MO absolute counts, HLA-DR expression, and stimulated IL-12 and TNF-alpha synthesis using flow cytometry. In addition, IL-12 and TNF-alpha release in stimulated whole blood cultures was assayed. RESULTS Whereas the absolute numbers of leukocytes and CD14+ MOs were significantly elevated, HLA-DR expression was suppressed postoperatively. The proportion of TNF-alpha- and IL-12-producing MOs was reduced after surgery. This, however, led to a significant postoperative decrease only in the absolute numbers of peripheral blood IL-12+ MOs. IL-12 secretion was postoperatively reduced in whole blood cultures. The IL-12-synthesizing capacity of IL-12+ MOs was significantly reduced only on d1. CONCLUSIONS The immediate postoperative period is associated with an increase in the absolute MO numbers and an impairment of MO function, which is reflected in a reduced capacity to synthesize IL-12 and TNF-alpha and a decreased ability to express HLA-DR and present antigens. Whereas the cytokine-producing capacity returns to normal levels on d3, the suppression of HLA-DR expression persists.
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Affiliation(s)
- Axel Franke
- Department of Trauma and Reconstructive Surgery, German Armed Forces Central Hospital, Koblenz, Germany
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Elahi MM, Yii M, Matata BM. Significance of oxidants and inflammatory mediators in blood of patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22:455-67. [PMID: 18503942 DOI: 10.1053/j.jvca.2007.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Maqsood M Elahi
- Wessex Cardiothoracic Centre, General/BUPA Hospitals, Southampton, United Kingdom
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Kurobe H, Kitaichi T, Shimahara Y, Kanemura T, Kanbara T, Kurushima A, Kano M, Hori T, Yoshida H, Urata M, Kitagawa T. Significance of peritoneal fluid drainage in management after repair of complex heart defects in infancy: cytokine dynamics in vivo. Circ J 2007; 71:941-7. [PMID: 17526994 DOI: 10.1253/circj.71.941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In vivo redundancy of pro-inflammatory cytokines results in a vicious cycle of systemic inflammatory response syndrome and low cardiac output syndrome (LOS). The purpose of this study was to elucidate the influence of peritoneal fluid (PF) drainage on cytokine dynamics in vivo and the significance of early induction for infants with LOS. METHODS AND RESULTS Seven infants, who underwent early PF drainage to manage LOS after repair of complex heart defects under cardiopulmonary bypass, were enrolled. The serum and PF levels of the pro- and antiinflammatory cytokines, interleukin (IL)-6, -8, -10 and tumor necrosis factor (TNF)-alpha, were measured during the perioperative period. Clinical outcomes were observed simultaneously. There were no cases of early or late death, or infectious complications. Drainage volume of PF peaked just after operation, and decreased completely. The amount of proinflammatory cytokines in the PF increased for 3 days after operation. Of the proinflammatory cytokines in the PF IL-6 increased the earliest and cleared the fastest. The amount of cleared IL-8 and TNF-alpha peaked on the 3rd postoperative day and resembled the course of C-reactive protein (CRP). Serum levels of CRP and proinflammatory cytokines in patients with PF drainage decreased significantly more than those without PF drainage. CONCLUSIONS Early initiation of PF drainage is useful in the postoperative critical care of infants with LOS by improving cytokine dynamics in vivo, although there are differences between the severity of patients undergoing PF drainage and those who do not.
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Affiliation(s)
- Hirotsugu Kurobe
- Department of Cardiovascular Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima 770-8503, Japan
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Franke A, Lante W, Markewitz A, Weinhold C. In Vitro Restoration of Post-Operatively Decreased IFN-Gamma Levels After Cardiac Surgery and Its Effect on Pro- and Anti-Inflammatory Mediators. J Surg Res 2006; 136:266-72. [PMID: 17054992 DOI: 10.1016/j.jss.2006.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 06/12/2006] [Accepted: 06/13/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND A decreased synthesis of interferon gamma (IFN-gamma) by TH 1 lymphocytes after cardiac operations with cardiopulmonary bypass (CPB) is part of the inflammatory response to local operative and systemic traumas. The consequences of this mechanism on the release of pro- and anti-inflammatory cytokines remain unclear. To evaluate the role of IFN-gamma, we added recombinant IFN-gamma to peripheral blood mononuclear cells (PBMCs) on the first post-operative day in an attempt to restore pre-operative values and then measured the release of pro- and anti-inflammatory cytokines in vitro. METHODS PBMCs of 10 patients scheduled for elective coronary artery bypass grafting (CABG) were obtained pre-operatively (d0) and on the first (d1) and third (d3) post-operative days. The release of IL-6, IL-8, TNF-alpha, IFN-gamma, IL-10, IL-2, and IL-4 was studied after stimulation (48 h) with PHA (phytohemagglutinin) and LPS (lipopolysaccharide) in the absence or presence of recombinant human IFN-gamma. RESULTS Endogenous IFN-gamma synthesis was suppressed on d1. Adding exogenous IFN-gamma restored IFN-gamma levels to normal on d1 and doubled IFN-gamma levels on d0 and d3. The addition of IFN-gamma increased TNF-alpha levels up to 250% on d1 and IL-2 synthesis by 75% on d1 and d3; the IL-2 levels, however, were still significantly depressed. The addition of recombinant IFN-gamma did not affect the synthesis of IL-6, IL-8, IL-10, and IL-4. CONCLUSIONS Contrary to our expectations, the in vitro release of IL-6 and IL-8 as well as IL-10 and IL-4 was not influenced by the addition of IFN-gamma. However, TNF-alpha production in isolated PBMC cultures increased significantly on the first post-operative day. This may indicate a hyper-reactivity of PBMCs to IFN-gamma and suggests that the decrease in IFN-gamma synthesis might prevent an excessive stimulation of the non-specific immune system by high TNF-alpha levels after cardiac surgery.
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Affiliation(s)
- Axel Franke
- Department of Cardiovascular Surgery, Bundeswehr Central Hospital, Koblenz, Germany.
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Franke A, Lante W, Kurig E, Zöller LG, Weinhold C, Markewitz A. Is Interferon Gamma Suppression After Cardiac Surgery Caused by a Decreased Interleukin-12 Synthesis? Ann Thorac Surg 2006; 82:103-9. [PMID: 16798198 DOI: 10.1016/j.athoracsur.2006.02.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2005] [Revised: 02/17/2006] [Accepted: 02/22/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The suppression of interferon gamma (IFN-gamma) synthesis after cardiac surgery is discussed as a cause of postoperative immunosuppression that predisposes to postoperative infectious complications. Because several studies have suggested that interleukin-12 (IL-12) production by monocytes and macrophages is reduced after cardiac surgery, this might cause a decrease in IFN-gamma release. To better understand these processes, we assessed the role of IL-12 in IFN-gamma synthesis in vitro before and after cardiac surgery. METHODS Heparinized whole blood samples were obtained from 20 patients undergoing elective cardiac surgery preoperatively (day 0) and on the first (day 1), third (day 3), and fifth (day 5) postoperative days, and stimulated (24 hours) with staphylococcal enterotoxin B and lipopolysaccharide. Recombinant IL-12 was added at each time point investigated. Interferon-gamma, IL-12, IL-2, IL-4, and IL-5 concentrations and histocompatibility leukocyte antigen-DR (HLA-DR) expression on monocytes and macrophages were assayed by flow cytometry. RESULTS The HLA-DR expression, IL-12 release, and IFN-gamma synthesis were significantly reduced on day 1, day 3, and day 5. Recovery began on day 3. Interleukin-12 caused a significant increase in IFN-gamma synthesis at each time point. When IL-12 was added, IFN-gamma synthesis returned to preoperative levels on days 3 and 5. CONCLUSIONS The synthesis of IFN-gamma is significantly reduced after cardiac surgery. The application of IL-12 causes an increase in IFN-gamma synthesis before surgery and a return of IFN-gamma to preoperative levels within a few days after surgery. These findings suggest that postoperative suppression of IFN-gamma release is caused by a decrease in IL-12 synthesis. In addition, IL-12 has a mainly proinflammatory effect both before and after surgery.
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Affiliation(s)
- Axel Franke
- Department of Cardiovascular Surgery, Bundeswehr Central Hospital, Koblenz, Germany.
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Blacher C, Neumann J, Jung LA, Lucchese FA, Ribeiro JP. Off-pump coronary artery bypass grafting does not reduce lymphocyte activation. Int J Cardiol 2005; 101:473-9. [PMID: 15907417 DOI: 10.1016/j.ijcard.2004.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Revised: 06/21/2004] [Accepted: 07/19/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In this study, we test the hypothesis that off-pump coronary bypass surgery might result in less lymphocyte activation than on-pump coronary surgery. We also study the behavior of lymphocyte activation markers during and after surgery. BACKGROUND Coronary artery bypass surgery is known to be associated with changes of inflammatory mediators, immune function, and early phase lymphocyte activation, which could cause postoperative lymphopenia and lymphocyte unresponsiveness. METHODS We studied lymphocyte activation response in 28 patients randomized to off-pump (n = 13) or on-pump (n = 15) coronary artery bypass surgery. Expression of CD25, CD26, CD69, and DR on T (CD3+) and B (CD19+) lymphocytes on peripheral blood was assessed through flow cytometry. RESULTS The response of T lymphocytes and their activation markers, as well as B lymphocytes and their activation markers, was similar after on- and off-pump surgery. Overall, T lymphocytes decreased to the lowest level 9 h after surgery and tended to increase later. For B lymphocytes, there was early reduction with increase on the 1st postoperative day. There was early activation of CD69+ and late activation of CD25+ on T lymphocytes. For B lymphocytes, there was early activation of CD69+ and late activation of DR+. CONCLUSIONS (1) Compared to on-pump cardiopulmonary bypass, off-pump surgery does not reduce lymphocyte activation. (2) Coronary bypass surgery causes the early activation of lymphocytes, as evidenced by the increased expression of lymphocyte activation markers.
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Affiliation(s)
- C Blacher
- Cardiology Disivion, Santa Casa de Misericórdia de Porto Alegre, RS, Brazil.
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Duffy JY, Schwartz SM, Lyons JM, Bell JH, Wagner CJ, Zingarelli B, Pearl JM. Calpain inhibition decreases endothelin-1 levels and pulmonary hypertension after cardiopulmonary bypass with deep hypothermic circulatory arrest*. Crit Care Med 2005; 33:623-8. [PMID: 15753756 DOI: 10.1097/01.ccm.0000156243.44845.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiopulmonary bypass in infants and children can result in cardiopulmonary dysfunction through ischemia and reperfusion injury. Pulmonary hypertension and injury are particularly common and morbid complications of neonatal cardiac surgery. Inhibition of calpain, a cysteine protease, has been shown to inhibit reperfusion injury in adult organ systems. The hypothesis is that calpain inhibition can alleviate the cardiopulmonary dysfunction seen in immature animals following ischemia and reperfusion with cardiopulmonary bypass. DESIGN Animal case study. SETTING Medical laboratory. SUBJECTS Crossbred piglets (5-7 kg). INTERVENTIONS Piglets were cooled with cardiopulmonary bypass to 18 degrees C followed by deep hypothermic circulatory arrest for 120 mins. Animals were rewarmed to 38 degrees C on cardiopulmonary bypass and maintained for 120 mins. Six animals were administered calpain inhibitor (Z-Leu-Leu-Tyr-fluoromethyl ketone; 1 mg/kg, intravenously) 60 mins before cardiopulmonary bypass. Nine animals were administered saline as a control. Plasma endothelin-1, pulmonary and hemodynamic function, and markers of leukocyte activity and injury were measured. MEASUREMENTS AND MAIN RESULTS Calpain inhibition prevented the increased pulmonary vascular resistance seen in control animals (95.7 +/- 39.4 vs. 325.3 +/- 83.6 dyne.sec/cm, respectively, 120 mins after cardiopulmonary bypass and deep hypothermic circulatory arrest, p = .05). The attenuation in pulmonary vascular resistance was associated with a blunted plasma endothelin-1 response (4.91 +/- 1.72 pg/mL with calpain inhibition vs. 10.66 +/- 6.21 pg/mL in controls, p < .05). Pulmonary function after cardiopulmonary bypass was better maintained after calpain inhibition compared with controls: Po2/Fio2 ratio (507.2 +/- 46.5 vs. 344.7 +/- 140.5, respectively, p < .05) and alveolar-arterial gradient (40.0 +/- 17.2 vs. 128.1 +/- 85.2 mm Hg, respectively, p < .05). Systemic oxygen delivery was higher after calpain inhibition compared with controls (759 +/- 171 vs. 277 +/- 46 mL/min, respectively, p < .001). In addition, endothelial nitric oxide synthase activity in lung tissue was maintained with calpain inhibition. CONCLUSIONS The reduction in plasma endothelin-1 and maintenance of lung endothelial nitric oxide levels after cardiopulmonary bypass and deep hypothermic circulatory arrest with calpain inhibition were associated with reduced pulmonary vascular resistance. Improved gas exchange and higher systemic oxygen delivery suggest that calpain inhibition may be advantageous for reducing postoperative cardiopulmonary dysfunction commonly associated with pediatric heart surgery and cardiopulmonary bypass.
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Affiliation(s)
- Jodie Y Duffy
- Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Connolly PH, Caiozzo VJ, Zaldivar F, Nemet D, Larson J, Hung SP, Heck JD, Hatfield GW, Cooper DM. Effects of exercise on gene expression in human peripheral blood mononuclear cells. J Appl Physiol (1985) 2004; 97:1461-9. [PMID: 15194674 DOI: 10.1152/japplphysiol.00316.2004] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Exercise leads to increases in circulating levels of peripheral blood mononuclear cells (PBMCs) and to a simultaneous, seemingly paradoxical increase in both pro- and anti-inflammatory mediators. Whether this is paralleled by changes in gene expression within the circulating population of PBMCs is not fully understood. Fifteen healthy men (18–30 yr old) performed 30 min of constant work rate cycle ergometry (∼80% peak O2 uptake). Blood samples were obtained preexercise (Pre), end-exercise (End-Ex), and 60 min into recovery (Recovery), and gene expression was measured using microarray analysis (Affymetrix GeneChips). Significant differential gene expression was defined with a posterior probability of differential expression of 0.99 and a Bayesian P value of 0.005. Significant changes were observed from Pre to End-Ex in 311 genes, from End-Ex to Recovery in 552 genes, and from Pre to Recovery in 293 genes. Pre to End-Ex upregulation of PBMC genes related to stress and inflammation [e.g., heat shock protein 70 (3.70-fold) and dual-specificity phosphatase-1 (4.45-fold)] was followed by a return of these genes to baseline by Recovery. The gene for interleukin-1 receptor antagonist (an anti-inflammatory mediator) increased between End-Ex and Recovery (1.52-fold). Chemokine genes associated with inflammatory diseases [macrophage inflammatory protein-1α (1.84-fold) and -1β (2.88-fold), and regulation-on-activation, normal T cell expressed and secreted (1.34-fold)] were upregulated but returned to baseline by Recovery. Exercise also upregulated growth and repair genes such as epiregulin (3.50-fold), platelet-derived growth factor (1.55-fold), and hypoxia-inducible factor-I (2.40-fold). A single bout of heavy exercise substantially alters PBMC gene expression characterized in many cases by a brisk activation and deactivation of genes associated with stress, inflammation, and tissue repair.
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Affiliation(s)
- Peter H Connolly
- Department of Pediatrics, University of California, Irvine, California 92697, USA
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Scheubel RJ, Zorn H, Silber RE, Kuss O, Morawietz H, Holtz J, Simm A. Age-dependent depression in circulating endothelial progenitor cells in patients undergoing coronary artery bypass grafting. J Am Coll Cardiol 2004; 42:2073-80. [PMID: 14680729 DOI: 10.1016/j.jacc.2003.07.025] [Citation(s) in RCA: 267] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The effect of patient age on circulating endothelial progenitor cells (EPCs) and their mobilization during coronary artery bypass grafting (CABG) was assessed. BACKGROUND The EPCs are able to contribute to reparative neovascularization after tissue ischemia. In experimental models, reparative neovascularization is impaired in senescent animals, but the role of EPCs in this impairment, especially in humans, is unknown. METHODS In 50 consecutive patients (43 to 80 years old) with stable coronary artery disease undergoing CABG, the numbers of EPCs and the plasma levels of interleukin (IL)-6, IL-8, IL-10, and IL-18, as well as vascular endothelial growth factor (VEGF) and placental growth factor, were determined preoperatively, after coming off bypass, and 6, 12, 24, and 72 h postoperatively. RESULTS Preoperative values of EPCs were lowered with increasing age, similar to the lowering of plasma VEGF levels. These age-associated decreases could not be explained by differences in atherosclerotic risk factors or cardiac function. Bypass surgery induced a rapid mobilization in EPCs, IL-6, IL-8, IL-10, and VEGF, with a peak 6 h postoperatively. Persistently lower levels of EPCs and VEGF throughout the observation period were observed in patients >69 years old, which could not be explained by differences in the operative procedure or inflammatory IL activation. CONCLUSIONS Despite a significant increase in EPCs and release of cytochemokines during CABG, age is a major limiting factor for mobilization of EPCs. Further studies are necessary to improve the strategies for mobilization, ex vivo expansion, and re-transplantation of EPCs in aging patients.
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Affiliation(s)
- Robert J Scheubel
- Department of Cardiothoracic Surgery, and Institute of Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Gu YJ, van Oeveren W. Time course of proinflammatory and anti-inflammatory responses after cardiac operation: monocyte HLA-DR expression. Ann Thorac Surg 2003; 76:654-5; author reply 655-6. [PMID: 12902136 DOI: 10.1016/s0003-4975(02)05020-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Franke A, Lante W, Markewitz A. Reply. Ann Thorac Surg 2003. [DOI: 10.1016/s0003-4975(02)05021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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