INFLAMMATORY RESPONSE AND OLIGO-ELEMENT ALTERATIONS FOLLOWING CARDIOPULMONARY BYPASS IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING

Oligo-elements such as zinc (Zn), selenium (Se) and copper (Cu) have a significant influence on the function of the immune system. Various i mmunological and inflammatory changes are known to occur in patients u ndergoing cardiopulmonary bypass. The aim of this study was to evaluat e changes in serum oligo-elements levels during and following cardiopu lmonary bypass. The serum levels of Zn, Se and Cu were determined in 6 7 consecutive patients, with coronary artery disease admitted for coro nary artery bypass grafting. Blood samples for oligo-elements, analysi s were withdrawn into metal-free tubes just prior to the start of card iopulmonary bypass: at 30, 60 and 90 min into cardiopulmonary bypass: following weaning from cardiopulmonary bypass: 30 min after terminatio n of cardiopulmonary bypass: at 24 h: and on the 5th postoperative day . Trace elements analyses were performed using atomic absorption spect rophotometry. Interleukin 6 and 8, as well as serum albumin, creatine phosphokinase. lactate dehydrogenase and creatine phosphokinase-MB fra ctions were also analyzed, The mean age was 63 +/- 9 years and 91% (61 ) were men. The mean preoperative left ventricular function was 52 +/- 12%, Canadian Cardiovascular Society (CCS) angina class was 3.7 +/- 0 .5 and 30% (20) of the operations were re-do's. All patients had normo thermic cardiopulmonary bypass. Mean cardiopulmonary bypass-time was 8 5 +/- 31 min. One patient was lost for the recovery sampling (hospital mortality, 1.5%), Nine patients had a postoperative cardiac index < 2 .0 liter/min per m(2), which required pharmacological support and addi tional intra-aortic balloon pump in two of them. Other postoperative c omplications were few, There was a rapid depletion of S-selenium and S -Zn levels, which were halved at 30 min after cardiopulmonary bypass a nd remained low throughout the study period. The Cu/Zn ratio increased significantly at the start of cardiopulmonary bypass, which indicated an inflammatory reaction and was not normalized until the 5th postope rative day. Length of ischemia time. presence of diabetes. hypertensio n and hyperlipidemia did not influence the results, while a prolonged cardiopulmonary bypass-time > 120 min resulted in a higher Cu/Zn ratio than observed for shorter cardiopulmonary bypass-times. This indicate s a more profound inflammatory response. Inflammatory parameters respo nded in the same manner as described earlier by others. These data ind icate that severe loss of various oligo elements occur in patients und ergoing coronary artery bypass grafting and suggests that a supplement ary administration of zinc and perhaps also selenium could be appropri ate during cardiopulmonary bypass. (C) 1998 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rig hts reserved.