The effect of cardiopulmonary bypass on systemic inflammatory response and organ dysfunction in patients with impaired left ventricular function undergoing coronary surgery

Cardiac surgery with cardiopulmonary bypass (CPB) causes systemic inflammatory response and multiple organ dysfunction that lead to increased morbidity and mortality rates. (2)The release of cytokines including tumor necrosis factor-alpha (TNF-?), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interferon-gamma (IFN-?) was reported to be the main reason of multiorgan failure after CPB (4). There?re limited data that report the association between the cardiopulmonary bypass-induced organ dysfunction and cytokin levels in patients with impaired left ventricular function.The major aim of the present study was to examine the relationship between cardiopulmonary bypass-induced organ dysfunction and cytokin levels in patients with impaired left ventricular function. The effects of hemodynamic parameters and preoperative demographics of the patients were also observed.Methods: 30 patients undergoing CABG those who had depressed left ventricular function (EF ? %35) were included in the study. Anesthesia was performed in accordance with institutional standards. Standard and invasive monitorization was performed under midazolame sedation. After the induction of anesthesia with fentanyl (3-5 ?cg/kg) and etomidate (titrating for all patients), 0.1 mg/kg vecuronium was administered and patients were intubated. Anesthesia was maintained with midazolame, fentanyl and sevoflurane.Peripheral blood samples for the assesment of TNF-?, IL-6, IL-8 and IL-10 levels were taken immediately after the induction of anesthesia (T0), 30 minutes (T1) after the beginning of CPB and on the 1th (T2), 3rd (T3), 6th (T4), 24th (T5) hours after the CPB. Hemodynamic parameters including mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), left ventricular end diastolic pressure (LVEDP) and cardiac index (CI) were also recorded in these time interval periods. Multiorgan dysfunction score (MODS) was recorded for 3 days after the surgery.Three patients was excluded from the study in order that the basal cytokine levels was high at the beginning.Results: The results of descriptive statistical analyze, Age (r=0.5, p=0.005), cross clamp duration (r=0.5, p=0.02), CPB duration (r=0.4, p=0.03 ), total dopamin usage (r=0.4, p=0.003), initial HR (r=0.4, p=0.04), HR of 3rd hour following CPB (r=-0.5, p=0.02), CVP (r=0.5, p=0.03) and IL-6 levels of 3rd and 6th hours following CPB (r=0.3, p= 0.02, r=0.4, respectively. p= 0.02) were significantly correlated with MODS. When these variables were analyzed with multiple regression analysis, only age (ß=0.5 p=0.001), HR (ß=0.3 p=0.001) and CVP of 3rd hour following CPB (ß=0.3 p=0.01) were independently associated with MODS.Conclusion: In conclusion, the present study on patients with impaired left ventricular function those underwent coronary arter surgery, shows the impact of inflammatory response on multiple organ disfunction following CPB. The patients with older age, higher preoperative heart rate, higher right filling pressures and impaired left ventricular function have increased possibility of multiple organ failure development. We suggest that, these patients should intensively be cared in terms of postoperative organ dysfunction.