CIRCULATING CYTOKINES AND GRANULOCYTE-DERIVED ENZYMES DURING COMPLEX HEART-SURGERY - A CLINICAL-STUDY WITH SPECIAL REFERENCE TO HEPARIN-COATING OF CARDIOPULMONARY BYPASS CIRCUITS

Blood contact with artificial surfaces during cardiopulmonary bypass ( CPB) triggers a systemic inflammatory response in which complement, gr anulocytes and cytokines play a major role. Heparin-coated CPB circuit s were recently shown to reduce complement and granulocyte activation in such circumstances. The present study comprised 20 complex heart op erations, 10 with heparin-coated circuits (group HC) and 10 controls ( group C), with evaluation of changes in terminal complement complex, t he granulocyte enzymes myeloperoxidase and lactoferrin, and the cytoki nes interleukin-6 (IL-6) and interleukin-8 (IL-8). Standard heparin do se and uncoated cardiotomy reservoir were used in all cases. In both g roups the levels of enzymes and terminal complement complex rose signi ficantly, beginning at conclusion of CPB, above base values, without s ignificant intergroup differences. IL-6 and IL-8 also increased signif icantly, but tended to be lower in the HC group, starting at CPB end a nd continuing until 20 hours postoperatively: for IL-6 the difference was significant at CPB end (83 +/- 18 vs 197 +/- 39 mu g/l, p = 0.21). Significantly increased inflammatory response was thus found during c omplex heart operations even with use of heparin-coated CPB sets. The heparin-coating of circuits seems to diminish cytokine production.