Kardiyopulmoner Bypassın Sitokinler Üzerine Etkisi

Year 2022, Volume: 5 Issue: 3, 413 - 420, 31.12.2022

Kadir Rastgeldi , Mehmet Salih Aydın , Bişar Amaç , Mustafa Abanoz

https://doi.org/10.36516/jocass.1160350

Abstract

Giriş: Kalbin normal fizyolojik çalışma durumu ile ekstrakorporeal dolaşım arasında önemli farklılıklar vardır. Ekstrakorporeal dolaşım sırasında, kanın vasküler endotelden farklı yapay materyal yüzeylerle temas etmektedir. Temas sırasında ve sonrasında metabolizmada, kanda, dokularda ve immün sistemde değişiklikler oluşmaktadır. Buda vücutta değişik reaksiyonlara yol açarak, sitokinlerin salınımına neden olabilmektedir.
Amaç: Yapılan bu çalışmanın amacı kardiyopulmoner bypass (KPB) eşliğinde yapılan kardiyak cerrahi operasyonlarında KPB'ın sitokinler üzerine etkisini araştırmaktır.
Yöntem: Çalışmaya KPB eşliğinde kardiyak cerrahi geçirmiş 15 erkek, 15 kadın hasta ve benzer demografik özelliklerde 30 sağlıklı birey kontrol grubu olarak dahil edildi. Hastalardan 5 farklı zamanda ve kontrol grubundan alınan kan numunelerinden ''Vasküler endotelyal büyüme faktörü (VEGF)'' düzeyleri çalışıldı. Sonuçlar istatistiksel olarak değerlendirildi.
Bulgular: Bu çalışmada; sağlıklı gönüllülerden (Kontrol grubu) ve hastalardan farklı zamanlarda alınan kan numunelerinin VEGF düzeyleri arasında istatistiksel olarak anlamlı fark vardı (p=0,045).
Sonuç: Çalışma sonucunda KPB sırasında ve KPB çıkışında VEGF seviyesinde anlamlı şekilde düşüş olduğu, bunun da cerrahi travma, prime solüsyonu, kardiyopleji ilaçları ve ekstrakorporeal dolaşım ekipmanı gibi nedenlere bağlı olduğunu düşünmekteyiz. Postoperatif servise çıkış dönemde ise normal seviyenin üzerine yükseldiği saptanmıştır. KPB eşliğinde yapılan kardiyak cerrahide ekstrakorporeal dolaşım ekipmanlarının inflamatuar yanıta neden olabileceğini bunun da postoperatif dönemde VEGF seviyesinde ciddi düzeyde yükselmeye neden olduğunu düşünmekteyiz.

Keywords

Kardiyopulmoner Bypass, Sitokinler, VEGF

Supporting Institution

Bu çalışma Harran Üniversitesi BAP birimi Araştırma Fon Saymanlığı tarafından desteklenmiştir.

Project Number

Proje numarası: 15017

Effects of Cardiopulmonary Bypass on Cytokines

Abstract

Introduction: There are significant differences between the normal physiological functioning of the heart and the extracorporeal circulation. During extracorporeal circulation, blood comes into contact with artificial material surfaces other than the vascular endothelium. During and after contact, changes occur in metabolism, blood, tissues and immune system. This can cause different reactions in the body, causing the release of cytokines.
Aim: The aim of this study is to investigate the effect of cardiopulmonary bypass (CPB) on cytokines in cardiac surgery operations performed with CPB.
Methods: Fifteen male and 15 female patients who had undergone cardiac surgery with CPB and 30 healthy individuals with similar demographic characteristics were included in the study as the control group. Vascular endothelial growth factor (VEGF) levels were studied from the blood samples taken from the patients at 5 different times and from the control group. The results were evaluated statistically.
Results: In this study; There was a statistically significant difference between VEGF levels of blood samples taken at different times from healthy volunteers (Control group) and patients (p=0.045).
Conclusion: As a result of the study, we think that there was a significant decrease in VEGF levels during and after CPB, due to reasons such as surgical trauma, priming solution, cardioplegia drugs and extracorporeal circulation equipment. It was found that it increased above the normal level in the postoperative period. We think that extracorporeal circulation equipment may cause inflammatory response in cardiac surgery performed with CPB, which causes a serious increase in VEGF level in the postoperative period.

Keywords

Cardiopulmonary Bypass, Cytokines, VEGF

Project Number

Proje numarası: 15017

References

• Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97(1):215-252. doi:10.1097/00000542-200207000-00030
• Larmann J, Theilmeier G. Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery. Best Pract Res Clin Anaesthesiol. 2004;18(3):425-438. doi:10.1016/j.bpa.2003.12.004
• Baehner T, Boehm O, Probst C, et al. Kardiopulmonaler bypass in der herzchirurgie [Cardiopulmonary bypass in cardiac surgery]. Anaesthesist. 2012;61(10):846-856. doi:10.1007/s00101-012-2050-0
• Deptula J, Glogowski K, Merrigan K, et al. Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery. J Extra Corpor Technol. 2006;38(1):22-26.
• Squiccimarro E, Labriola C, Malvindi PG, et al. Prevalence and Clinical Impact of Systemic Inflammatory Reaction After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2019;33(6):1682-1690. doi:10.1053/j.jvca.2019.01.043
• Poldermans D, Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003;107(14):1848-1851. doi:10.1161/01.CIR.0000066286.15621.98
• Dvorak HF, Brown LF, Detmar M, Dvorak AM. Vascular permeability factor/vascular endothelial growth factor, microvascular hyperpermeability, and angiogenesis. Am J Pathol. 1995;146(5):1029-1039.
• Rini BI, Small EJ. Biology and clinical development of vascular endothelial growth factor—targeted therapy in renal cell carcinoma. J Clin Oncol. 2005;23:1028-1043. PMID: 15534359
• Gorjipour F, Totonchi Z, Gholampour Dehaki M, et al. Serum levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, renal function biochemical parameters and clinical outcomes in pediatric cardiopulmonary bypass surgery. Perfusion. 2019;34(8):651-659. doi:10.1177/0267659119842470
• Fujii Y. Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model. Biology (Basel). 2020;9(4):81. Published 2020 Apr 20. doi:10.3390/biology9040081
• Suzuki H, Oshima N, Watari T. Effect of modified ultrafiltration on cytokines and hemoconcentration in dogs undergoing cardiopulmonary bypass. J Vet Med Sci. 2020;82(11):1589-1593. doi:10.1292/jvms.20-0143
• Naase H, Harling L, Kidher E, et al. Toll-like receptor 9 and the inflammatory response to surgical trauma and cardiopulmonary bypass. J Cardiothorac Surg. 2020;15(1):137. Published 2020 Jun 11. doi:10.1186/s13019-020-01179-y
• Tu LN, Hsieh L, Kajimoto M, et al. Shear stress associated with cardiopulmonary bypass induces expression of inflammatory cytokines and necroptosis in monocytes. JCI Insight. 2021;6(1):e141341. Published 2021 Jan 11. doi:10.1172/jci.insight.141341
• Kankılıç N, Aydın MS, Göz M. The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass [published online ahead of print, 2021 Oct 21]. Braz J Cardiovasc Surg. 2021;10.21470/1678-9741-2020-0466. doi:10.21470/1678-9741-2020-0466
• Mirhafez SR, Khadem SH, Sahebkar A, et al. Comparative effects of on-pump versus off-pump coronary artery bypass grafting surgery on serum cytokine and chemokine levels. IUBMB Life. 2021;73(12):1423-1431. doi:10.1002/iub.2566
• Bai Y, Zhang Y, Yang S, et al. Protective effect of vascular endothelial growth factor against cardiopulmonary bypass-associated acute kidney injury in beagles. Exp Ther Med. 2018;15(1):963-969. doi:10.3892/etm.2017.5460