INFLAMMATORY RESPONSE AFTER MYOCARDIAL REVASCULARIZATION WITH OR WITHOUT CARDIOPULMONARY BYPASS

Background. Tumor necrosis factor-alpha has been implicated in complic ations seen after cardiac operations with cardiopulmonary bypass. The release of tumor necrosis factor-alpha and its possible effects were s tudied in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.Methods. Twenty patients were studied, 10 with (group 1) and 10 without cardiopulmonary bypass (group 2). Se rial blood samples were obtained before, during and up to 48 hours aft er operation. Circulating tumor necrosis factor-alpha levels, leukocyt e counts, and erythrocyte sedimentation rates were measured. Hemodynam ic variables (blood pressure and heart rate), temperature, orotracheal intubation time, postoperative bleeding, and inotropic drug requireme nts were compared. Results, Serum levels of tumor necrosis factor-alph a were detected in 6 patients (60%) in group 1 and none in group 2. Th e patients in group 1 had more hypotension than those in group 2 (7.4 +/- 1.0 mm Hg versus 8.5 +/- 0.7 mm Hg), required more inotropic drugs (8 patients versus 1 patient), and had a higher heart rate (114 +/- 8 beats per minute versus 98 +/- 10 beats per minute), a higher tempera ture (37.1 degrees +/- 0.5 degrees C versus 36.6 degrees +/- 0.3 degre es C), increased postoperative bleeding (820 +/- 120 mL versus 360 +/- 84 mL), a longer orotracheal intubation time (13.6 +/- 2.2 hours vers us 9.3 +/- 1.4 hours), and a more pronounced leukocytosis. Conclusions . Cardiopulmonary bypass induces the whole-body inflammatory response through the release of tumor necrosis factor ct, resulting in adverse systemic effects, (Ann Thorac Surg 1998;66:56-9) (C) 1998 by The Socie ty of Thoracic Surgeons.