The effect of interleukins on post operative morbidity of open heart surgery with cardiopulmonary by-pass

ABSTRACT THE EFFECT OF INTERLEUKINS ON POST OPERATIVE MORBIDITY OF OPEN HEART SURGERY WITH CARDIOPULMONARY BY-PASS Cardiopulmonary bypass is fundamental for a variety of cardiac operations. Despite advances in anesthetic, surgical and perfusion techniques, cardiopulmonary bypass has an inflammatory effect through the release of proinflammatory substances which in turn cause a deleterious effect on pulmonary, renal, coagulatory, neurological systems and cause the clinical picture known as the postperfusion syndrome. Elucidating the role of citokines in inflammation related to cardiopulmonary bypass through the modulation of these agents will decrease the mortality and morbidity related to cardiopulmonary bypass. In a prospective study, 34 patients were assigned to two groups; Group one (Study group) consisted of patients undergoing elective coronary bypass and valvular surgery with cardiopulmonary bypass (17) and Group 2 (Control group) consisted of patients operated for thoracic lesions without cardiopulmonary bypass (17). Interleukin levels (IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-1 2) of these two groups were compared and in the study group subsets of patients for cardiopulmonary bypass duration, cross clamping time, extubation time, intensive care unit stay and need for supportive therapy were compared. Our research showed no previous study for the simultaneous effect of cardiopulmonary bypass on interleukins collectively and their relation to morbidity. Likewise no study for the effect of cardiopulmonary bypass on IL-1 2 was found. In this study interleukins were studied simultaneously to enlighten their role in morbidity following cardiopulmonary bypass.The IL-1, IL-2, IL-6, IL-8, IL-10, IL-1 2 values were significantly higher in the Study group. In the comparison for subsets of Group 1, IL-1, IL-2, IL6, IL-1 2 levels were significantly higher in the subsets with longer cardiopulmonary bypass, cross clamp time,extubation time and intensive care unit stay; IL-1, IL-2, IL-1 2 levels were significantly higher in patients requiring supportive therapy. These results preclude IL-1, IL-2, IL-6 and IL-1 2 levels to be valuable markers for post operative morbidity. There were no significant changes for the results of IL-4 and this was in accordance with literature. In the comparison of IL-8 and IL-10 for the subsets of the working group no statistically significant change or increase were noted. A larger study group might be needed to demonstrate the value of these cytokines. A thorough understanding of circumstances initiating interleukin release and comprehension of the exact mechanisms of cytokine related interactions will enable interventional therapies which will decrease postoperative mortality and morbidity immensely. KEY WORDS: Cardiopulmonary bypass, Interleukin, Postoperative morbidity. VII