Evaluation of relationship between duration of cross clemp and level of neopterin in open heart surgery

AIM: Cardiopulmonary bypass that has a great role in the place where cardiopulmonary surgery is today has been discussed and researced for a long time because of the complicatons besides the advantages it causes. Immunologic disfunction caused by cardiopulmonary bypass that affects the life quality is one of the important problems that is caused by cardiopulmonary bypass. During cardiopulmonary bypass immunologic defense cells and proteins are activated since the blood comes in contact with different materials. .In this study neopterin levels are studied in on pump cardiac surgery patients by evaluation of the relation among the cross clamping time and the neopterin levels to determine its usability as an early sign of inflammation in open heart surgery.MATERIALS AND METHOD:14 male and 6 female patients that is going to have an open heart surgery with 50% and over left ventricule ejection fraction is taken to this study. . Mean age of these 20 patients were 60.2± 7.8 years. WBC, CRP, and neopterin levels were measured in blood sampels drawn preoperatively and in 4,24 and 72. hours after the operation. Neopterin leves were compared with levels in patients with adherent disease (DM, CKF). Statistically significance is studied between cross clamping and bypass time.RESULTSWBC, CRP and neopterin levels that can be expected as early inflammation markers were found stastically significant in this study. Correlation between immunological disfunction and adherent disease presence, long survey of cardiopulmonary bypass and clamping time was not statist,cally significant. 20 % patients were female and 70 % were male in this study. Mean age were 52,7±9,2 im female and 63,4±5,5 in male group. The gruop with the highest risk of immunological disfunction is stated to be the elder age ((>65) in patients with chronic kidney failure (1-16,3,7). Statistically significance was not found between age and neopterin levels in this study. Gender distribution was not statistically significant although the patient were few in number (p>0.05). Significant difference was not found between the neopterin levels with different gender in patients who had cardiopulmonary bypass operation. Preoperative and 24th and 72 nd hour posroperative neoprerin levels were not statistically different although the neopterin levels were higher postoperatively. (p>0.05). Neopterin levels were higher in 4th hour after the operation in both sexes statistically significantly. (p<0.05) Shapiro wilk test was used for normality controls of rhe findings and student T test and wicoxon test were used for comparison of the groups. Findings were evaluated with SPSS 17.0 program. Results were stated as mean Standard error(SE).CONCLUTION:Cardiopulmonary bypass operation and cardioplegic arrest have several undesired effects. In cardiopulmonary operations, bypass and cross clamping time have an effect on immunological injury and data has shown worsening of this effect with elongation of this procedure. Neopterin is an immunological indicator showing cellular immune sistem activation. Neopterin is secreted from monocyte and macropages with the effect of IF- gamma secreted from actived T cells.. Elevation of neopterin level in body fluids has been proven in otoimmune diseases caused by cellulary immune system, infections, allograft rejection nad malignancies. In this study; altough serum neopterin levels were found increased in patients postoperatively the disease activation was not found correlated. This uncorrelation might have been caused by the descrease in the number of patients, further studies with larger number of patient is needed.