The effect of combined use of blood ultrafiltration and various priming solutions of cardipulmonary bypass on inflammatory markers in adult cardiac surgery

Authors

  • Олена Миколаївна Клигуненко Intensive Care end Emergency Medicine FPE SE «Dnipropetrovsk medical academy of the MH of Ukraine», Ukraine https://orcid.org/0000-0002-0856-0809
  • Володимир Володимирович Яровенко RE « Dnipropetrovsk region clinical center of cardiology and cardiosurgery» DRC Plechanova str., 28, Dnipropetrovsk, Ukraine, 49070, Ukraine https://orcid.org/0000-0001-9174-3683

DOI:

https://doi.org/10.15587/2519-4798.2016.72534

Keywords:

cardiopulmonary bypass, heart surgery, cytokines, Hydroxyethylstarch 130/0, 4, modified gelatine, ultrafiltration

Abstract

Aim of the given research is to evaluate the influence of blood ultrafiltation during cardiopulmonary bypass (CPB) with primary circuit filling by various colloidal solutions on systemic inflammatory response markers in adult patients after heart valve replacement.

Materials and methods. The study included 115 patients after heart valve replacement. They were randomly assigned into four groups depending on the type of fluid to fill the cardiopulmonary bypass (CPB) and blood ultrafiltration use. The first group (п=37) received modified gelatine 4 % solution for CPB filling. Hydroxyethylstarch 130/0,4 was administered in the original volume filling for the third group of patients (п=35). Blood ultrafiltration prior to CPB finishing was carried out in patients of second group (n=21) and fourth group (n=22). The inflammatory markers concentration (IL-1α, IL-6, TNF-a, IL-10) were studied in serum samples before intubation (1), after CPB finishing (2) and on the first day after surgery (3). The levels measurement (IL-1α, IL-6, TNF-a, IL-10) was carried out using commercially available enzyme-linked immunosorbent assay (Diaclone). Statistical data analysis was carried out using Statistica 6.0 with Schapiro, Wilkie, Wilcoxon, Kruskal-Wallis criteria (ANOVA by rank test). The value of p <0.05 was considered as reliable.

Results. Any significant differences between groups in distribution according to age, male and female ratio, patients preoperative clinical status, CPB duration, and aortic clamp were not detected. Results have shown, that the TNF α and IL 6 levels in serum after CBP finishing and on the first day after surgery were considerably lower in the fourth group of patients. The IL-10 concentration in the fourth group was considerably higher after CBP and during the first day after surgery. The number of leukocytes increased in all groups, but it was considerably lower in the fourth group after CBP and during the first day after surgery. Besides, this group required shorter time of ventilation (р=0,0000), inotropic agents administration (р=0,02), intensive therapy unit (р=0,0018) and hospitalization (р=0,016,) comparing with the other groups.

Conclusion. It has been fouond, that ultrafiltration removes from the circulating inflammatory cytokines and increases anti-inflammatory IL 10 level. It reduces the treatment duration and the number of complications

Author Biographies

Олена Миколаївна Клигуненко, Intensive Care end Emergency Medicine FPE SE «Dnipropetrovsk medical academy of the MH of Ukraine»

PhD, professor, head of department

Department of Anaesthesiology

Володимир Володимирович Яровенко, RE « Dnipropetrovsk region clinical center of cardiology and cardiosurgery» DRC Plechanova str., 28, Dnipropetrovsk, Ukraine, 49070

Anaesthesiologyst

Department of Anaesthesiology and Intensive Care

References

  1. Handzyuk, V. A. (2014). Dynamika zahvorjuvanosti ta poshyrenosti hvorob systemy krovoobigu sered naselennja Ukrai'ny na suchasnomu etapi: nacional'nyj ta regional'nyj aspekty. Journal of Social Hygiene and Health Organization Ukraine, 2 (60), 74–78.
  2. Kovalenko, V. N., Kornatsky, V. N. (2011). Regional features of health of the people of Ukraine. Kiev, 166.
  3. Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A. et. al (2014). 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. Journal of the American College of Cardiology, 63 (22), 2438–2488. doi: 10.1016/j.jacc.2014.02.537
  4. Stoney, W. S. (2009). Evolution of Cardiopulmonary Bypass. Circulation, 119 (21), 2844–2853. doi: 10.1161/circulationaha.108.830174
  5. DiSesa, V. J., O’Brien, S. M., Welke, K. F., Beland, S. M., Haan, C. K., Vaughan-Sarrazin, M. S., Peterson, E. D. (2006). Contemporary Impact of State Certificate-of-Need Regulations for Cardiac Surgery An Analysis Using the Society of Thoracic Surgeons’ National Cardiac Surgery Database. Circulation, 114 (20), 2122–2129. doi: 10.1161/circulationaha.105.591214
  6. Hall, R. (2013). Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 27 (5), 983–1033. doi: 10.1053/j.jvca.2012.09.013
  7. Warren, O. J., Smith, A. J., Alexiou, C., Rogers, P. L. B., Jawad, N., Vincent, C. et. al (2009). The Inflammatory Response to Cardiopulmonary Bypass: Part 1–Mechanisms of Pathogenesis. Journal of Cardiothoracic and Vascular Anesthesia, 23 (2), 223–231. doi: 10.1053/j.jvca.2008.08.007
  8. Oikonomou, E., Tousoulis, D., Siasos, G., Zaromitidou, M., Papavassiliou, A. G., Stefanadis, C. (2011). The Role of Inflammation in Heart Failure: New Therapeutic Approaches. Hellenic J Cardiol, 52 (1), 30–40.
  9. Nearman, H., Klick, J. C., Eisenberg, P., Pesa, N. (2014). Perioperative Complications of Cardiac Surgery and Postoperative Care. Critical Care Clinics, 30 (3), 527–555. doi: 10.1016/j.ccc.2014.03.008
  10. Bruggemans, E. F. (2012). Cognitive dysfunction after cardiac surgery: Pathophysiological mechanisms and preventive strategies. Netherlands Heart Journal, 21 (2), 70–73. doi: 10.1007/s12471-012-0347-x
  11. Zamora, E., Delgado, L., Castro, M. A., Fernández, M., Orrit, J., Romero, B. et. al (2008). Coronary artery bypass surgery using the mini-extracorporeal circulation system: a Spanish unit’s experience. Revista Española de Cardiología (English Edition), 61 (4), 376–381. doi: 10.1016/s1885-5857(08)60138-3
  12. Warren, O. J., Tunnicliffe, C. R., Massey, R. M., Wallace, S., Smith, A. J., Alcock, E. M. H. et. al (2008). Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass. ASAIO Journal, 54 (1), 78–88. doi: 10.1097/mat.0b013e3181618e9b
  13. Koike, T., Tsuchida, M., Saitoh, M., Haga, M., Satoh, K., Aoki, T. et. al (2009). Protective Mechanism of Ultrafiltration Against Cardiopulmonary Bypass–Induced Lung Injury. Transplantation Proceedings, 41 (9), 3845–3848. doi: 10.1016/j.transproceed.2009.04.010
  14. Papadopoulos, N., Bakhtiary, F., Grun, V., Weber, C., Strasser, C., Moritz, A. (2013). The effect of normovolemic modified ultrafiltration on inflammatory mediators, endotoxins, terminal complement complexes and clinical outcome in high-risk cardiac surgery patients. Perfusion, 28 (4), 306–314. doi: 10.1177/0267659113478450
  15. Choi, Y. S., Shim, J. K., Hong, S. W., Kim, J. K., Kwak, Y. (2010). Comparing the effects of 5 % albumin and 6 % hydroxyethyl starch 130/0.4 on coagulation and inflammatory response when used as priming solutions for cardiopulmonary bypass. Minerva Anestesiol, 76 (8), 584–591.
  16. Liou, H.-L. (2012). Inflammatory Response to Colloids Compared to Crystalloid Priming in Cardiac Surgery Patients with Cardiopulmonary Bypass. The Chinese Journal of Physiology, 55 (3), 210–218. doi: 10.4077/cjp.2012.baa028
  17. Babayev, M. A., Eremenko, A. A., Vinnitskiy, L. I., Bunyatyan, K. A. (2010). Causes of multiple organ failure in cardiac surgery with cardiopulmonary bypass. General resuscitation.,VI (3), 76–81.
  18. Liu, J., Ji, B., Long, C., Li, C., Feng, Z. (2007). Comparative Effectiveness of Methylprednisolone and Zero-balance Ultrafiltration on Inflammatory Response After Pediatric Cardiopulmonary Bypass. Artificial Organs, 31 (7), 571–575. doi: 10.1111/j.1525-1594.2007.00423.x
  19. Berdat, P. (2004). Elimination of proinflammatory cytokines in pediatric cardiac surgery: analysis of ultrafiltration method and filter type. Journal of Thoracic and Cardiovascular Surgery, 127 (6), 1688–1696. doi: 10.1016/s0022-5223(04)00254-5
  20. Torina, A. G., Silveira-Filho, L. M., Vilarinho, K. A. S., Eghtesady, P., Oliveira, P. P. M., Sposito, A. C., Petrucci, O. (2012). Use of modified ultrafiltration in adults undergoing coronary artery bypass grafting is associated with inflammatory modulation and less postoperative blood loss: A randomized and controlled study. The Journal of Thoracic and Cardiovascular Surgery, 144 (3), 663–670. doi: 10.1016/j.jtcvs.2012.04.012
  21. Emelyanovа, T. V., Svirko, Y. S., Podoksenov, J. K. (2009). Methods for reducing systemic inflammation in cardiac surgical patients undergoing surgery with cardiopulmonary bypass. Fundamental aspects of the treatment of heart failure in cardiac surgery. Tomsk, 12-28.
  22. Grünenfelder, J. (2000). Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults. European Journal of Cardio-Thoracic Surgery, 17 (1), 77–83. doi: 10.1016/s1010-7940(99)00355-3
  23. Jaffer, U., Wade, R. G. (2010). Cytokines in the systemic inflammatory response syndrome: a review. HSR Proc Intensive Care Cardiovasc Anesth, 2 (3), 161–175.
  24. Boehm, J., Hauner, K., Grammer, J., Dietrich, W., Wagenpfeil, S., Braun, S. et. al (2011). Tumor necrosis factor-α –863 C/A promoter polymorphism affects the inflammatory response after cardiac surgery. European Journal of Cardio-Thoracic Surgery, 40 (1), e50–e54. doi: 10.1016/j.ejcts.2011.01.084
  25. Chen, C.-J., Kono, H., Golenbock, D., Reed, G., Akira, S., Rock, K. L. (2007). Identification of a key pathway required for the sterile inflammatory response triggered by dying cells. Nature Medicine, 13 (7), 851–856. doi: 10.1038/nm1603
  26. Basran, A., Jabeen, M., Bingle, L., Stokes, C. A., Dockrell, D. H., Whyte, M. K. B. et. al (2012). Roles of neutrophils in the regulation of the extent of human inflammation through delivery of IL-1 and clearance of chemokines. Journal of Leukocyte Biology, 93 (1), 7–19. doi: 10.1189/jlb.0512250
  27. Sabata, R., Grützc, G., Warszawskaa, K., Kirscha, S., Wittea, E., Wolk, K. (2010). Biology of interleukin-10. Cytokine & Growth Factor Reviews, 21 (5), 331–344. doi: 10.1016/j.cytogfr.2010.09.002
  28. Elahi, M. M., Yii, M., Matata, B. M. (2008). Significance of Oxidants and Inflammatory Mediators in Blood of Patients Undergoing Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 2 2(3), 455–467. doi: 10.1053/j.jvca.2007.12.022
  29. Tallman, R. D., Dumond, M., Brown, D. (2002). Inflammatory mediator removal by zero-balance ultrafiltration during cardiopulmonary bypass. Perfusion, 17 (2), 111–115. doi: 10.1191/0267659102pf540oa
  30. Zakkar, M., Guida, G., Angelini, G. D. (2014). Modified ultrafiltration in adult patients undergoing cardiac surgery. Interactive CardioVascular and Thoracic Surgery, 20 (3), 415–421. doi: 10.1093/icvts/ivu388
  31. De Vriese, A. S., Colardyn, F. A., Philippé, J. J., Vanholder, R. C., De Sutter, J. H., Lameire, N. H. (1999). Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol, 10 (4), 846–853.
  32. Song, L., Yinglong, L., Jinping, L. (2007). Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass. Perfusion, 22 (5), 339–343. doi: 10.1177/0267659107086726
  33. Tao, Z., Gao, C.-q., Li, J.-c., Wang, J.-l., Li, L.-b., Xiao, C.-s. (2009). Effect of subzero-balanced ultrafiltration on postoperative outcome of patients after cardiopulmonary bypass. Perfusion, 24 (6), 401–408. doi: 10.1177/0267659109357977

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Published

2016-06-30

How to Cite

Клигуненко, О. М., & Яровенко, В. В. (2016). The effect of combined use of blood ultrafiltration and various priming solutions of cardipulmonary bypass on inflammatory markers in adult cardiac surgery. ScienceRise: Medical Science, (6 (2), 32–41. https://doi.org/10.15587/2519-4798.2016.72534

Issue

No. 6 (2) (2016)

Section

Medical Science

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Copyright (c) 2016 Олена Миколаївна Клигуненко, Володимир Володимирович Яровенко

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