Abstract
Background: Cardiopulmonary bypass (CPB) has long been recognised as a main cause of a postoperative complex systemic inflammatory response after coronary artery bypass grafting (CABG).
Methods: We determined the kinetics of peripheral blood release of the novel inflammatory biomarkers secretory phospholipase A2 (sPLA2), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) during the first 6 days following surgery in 16 patients undergoing CABG with (on-pump, n=9) or without (off-pump, n=7) CPB. Kinetic curves for these markers were compared to those of the well-known inflammatory parameters C-reactive protein (CRP) and fibrinogen.
Results: sPLA2 activity exhibited a maximum value on day 2, then decreased until day 6 for both groups and in a similar manner as CRP levels. On the other hand, elevation of plasma levels of both MMP-9 and TIMP-1 occurred as early as on day 1 and remained at this level until day 6. No significant difference in kinetic characteristics (peak value, area under the curve, initial slope) between CABG with and without CPB was observed.
Conclusions: These data show that the off- and on-pump groups did not show significantly different kinetics for the releases of all biomarkers studied, including sPLA2 and biomarkers of the MMP-TIMP network. The off-pump procedure may therefore lead to global surgical trauma as important as CPB in terms of the systemic inflammatory process and matrix proteolysis pathway activation.
Clin Chem Lab Med 2007;45:372–5.
References
1. Pintar T, Collard CD. The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin N Am2003;21:453–64.10.1016/S0889-8537(03)00039-7Search in Google Scholar
2. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg2002;21:232–44.10.1016/S1010-7940(01)01099-5Search in Google Scholar
3. Hazama S, Eishi K, Yamachika S, Noguchi M, Ariyoshi T, Takai H, et al. Inflammatory response after coronary revascularization: off-pump versus on-pump (heparin-coated circuits and pol2methoxyethylacrylate-coated circuits). Ann Thorac Cardiovasc Surg2004;10:90–6.Search in Google Scholar
4. Wehlin L, Vedin J, Vaage J, Lundahl J. Activation of complement and leukocyte receptors during on- and off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg2004;25:35–42.10.1016/S1010-7940(03)00652-3Search in Google Scholar
5. Van den Goor J, Nieuwland R, van den Brink A, van Oeveren W, Rutten P, Tijssen J, et al. Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response. Eur J Cardiothorac Surg2004;26:926–31.10.1016/j.ejcts.2004.07.035Search in Google Scholar PubMed
6. Aouifi A, Piriou V, Bouvier H, Bastien O, Chiari P, Chiari P, et al. Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations. Br J Anesth1999;83:602–7.10.1093/bja/83.4.602Search in Google Scholar PubMed
7. Vaneck T, Brucek P, Strakaz Z, Klepetar J, Maly M. Development of C-reactive protein and fibronectin levels in coronary surgery patients. Jpn Heart J2002;43:211–8.10.1536/jhj.43.211Search in Google Scholar PubMed
8. Menschikowski M, Hagelgans A, Siegert G. Secretory phospholipase A2 of group IIA: is it an offensive or a defensive player during atherosclerosis and other inflammatory diseases? Prostagl Other Lipid Mediat2006;79:1–33.10.1016/j.prostaglandins.2005.10.005Search in Google Scholar PubMed
9. Hartford M, Wiklund O, Mattsson Hulten L, Perers E, Person A, Herlitz J, et al. CRP, interleukin-6, secretory phospholipase A2 group IIA, and intercellular adhesion molecule-1 during the early phase of acute coronary syndromes and long-term follow-up. Int J Cardiol2006;108:55–62.10.1016/j.ijcard.2005.04.004Search in Google Scholar PubMed
10. Beaudeux JL, Giral P, Bruckert E, Foglietti MJ, Chapman MJ. Matrix metalloproteinases, inflammation and atherosclerosis: therapeutic perspectives. Clin Chem Lab Med2004;42:121–31.10.1515/CCLM.2004.024Search in Google Scholar PubMed
11. Squire IB, Evans J, Ng LL, Loftus IM, Thompson MM. Plasma MMP-9 and MMP-2 following acute myocardial infarction in man: correlation with echographic and neurohumoral parameters of left ventricular dysfunction. J Cardiac Fail2004;10:328–33.10.1016/j.cardfail.2003.11.003Search in Google Scholar PubMed
12. Eckart RE, Uyehara CFT, Shry EA, Furgerson JL, Krasuski RA. Matrix metalloproteinases in patients with myocardial infarction and percutaneous revascularization. J Interven Cardiol2004;17:1–5.10.1111/j.1540-8183.2004.00289.xSearch in Google Scholar PubMed
13. Garner JR, Stroud RE, Finklea L, Ikonomidis JS, Dorman BH, Spinale FG. The effect of leukocyte reduction on matrix metalloproteinase release in cardiopulmonary bypass. J Extra Corpor Technol2004;36:185–90.Search in Google Scholar
14. Schneider S, Gunasinghe H, Sistino J, Blackwell M, Spinale F. Effects of leukocyte depletion filters on matrix metalloproteinase activation in an extracorporeal circulation circuit. J Extra Corpor Technol2003;35:139–42.Search in Google Scholar
15. Lin TC, Li CY, Tsai CS, Ku CH, Wong CS, Ho ST. Neutrophil-mediated secretion and activation of matrix metalloproteinase-9 during cardiac surgery with cardiopulmonary bypass. Anesth Analg2005;100:1554–60.10.1213/01.ANE.0000154307.92060.84Search in Google Scholar PubMed
16. Murphy GJ, Ascione R, Angelini GD. Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade? Eur Heart J2004;25:2077–85.10.1016/j.ehj.2004.09.022Search in Google Scholar PubMed
17. Ngaage DL. Off-pump coronary artery bypass grafting: simple concept but potentially sublime scientific value. Med Sci Monit2004;10:RA47–54.Search in Google Scholar
18. Mallat Z, Steg PG, Benessiano J, Tanguy ML, Fox KA, Collet JP, et al. Circulating secretory phospholipase A2 activity predicts recurrent events in patients with severe acute coronary syndromes. J Am Coll Cardiol2005;46:1249–57.10.1016/j.jacc.2005.06.056Search in Google Scholar PubMed
19. Gaudino M, Zamparelli R, Andreotti F, Burzotta F, Iacoviello L, Glieca F, et al. Normothermia does not improve postoperative hemostasis nor does reduce inflammatory activation in patients undergoing primary isolated coronary artery bypass. J Thoracic Cardiovasc Surg2002;123:1092–100.10.1067/mtc.2002.120709Search in Google Scholar PubMed
20. Kilger E, Pichler B, Goetz AE, Rank N, Welte M, Morstedt K, et al. Procalcitonin as a marker of systemic inflammation after conventional or minimally invasive coronary artery bypass grafting. Thorac Cardiovasc Surg1998;46:130–3.10.1055/s-2007-1010209Search in Google Scholar PubMed
21. Fransen E, Maessen J, Dentener M, Senden N, Geskes G, Buurman W. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest1998;113:1290–5.10.1378/chest.113.5.1290Search in Google Scholar PubMed
22. Guidet B, Piot O, Masliah J, Barakett V, Maury E, Bereziat G, et al. Secretory non-pancreatic phospholipase A2 in severe sepsis: relation to endotoxin, cytokines and thromboxane B2. Infection1996;24:103–8.10.1007/BF01713312Search in Google Scholar PubMed
23. Boekholdt SM, Keller TT, Wareham NJ, Luben R, Bingham SA, Day NE, et al. Serum levels of type II secretory phospholipase A2 and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk Prospective Population Study. Arterioscler Thromb Vasc Biol2005;25:839–46.10.1161/01.ATV.0000157933.19424.b7Search in Google Scholar PubMed
24. Hartford M, Wiklund O, Mattsson Hulten L, Perers E, Person A, Herlitz J, et al. CRP, interleukin-6, secretory phospholipase A2 group IIA, and intercellular adhesion molecule-1 during the early phase of acute coronary syndromes and long-term follow-up. Int J Cardiol2006;108:55–62.10.1016/j.ijcard.2005.04.004Search in Google Scholar PubMed
25. Liu PY, Li YH, Tsai WC, Chao TH, Tsai LM, Wu HL, et al. Prognostic value and the changes of plasma levels of secretory type II phospholipase A2 in patients with coronary artery disease undergoing percutaneous coronary intervention. Eur Heart J2003;24:1824–32.10.1016/j.ehj.2003.07.003Search in Google Scholar
26. Bruins P, te Velthuis H, Jansen P, Eijsman L, Hack CE. Biphasic release of secretory phospholipase A2 during and after cardiopulmonary bypass. J Thorac Cardiovasc Surg1998;115:949–51.10.1016/S0022-5223(98)70380-0Search in Google Scholar
27. Joffs C, Gunasinghe HR, Multani MM, Dorman BH, Kratz JM, Crumbley AJ III, et al. Cardiopulmonary bypass induces the synthesis and release of matrix metalloproteinases. Ann Thorac Surg2001;71:1518–23.10.1016/S0003-4975(01)02442-0Search in Google Scholar
28. Steinberg J, Fink G, Searles B, Schiller H, Lee HM, Nieman G. Evidence of increased matrix metalloproteinase-9 in patients following cardiopulmonary bypass. J Extra Corpor Technol2001;33:218–22.Search in Google Scholar
29. Galley HF, Macauley GD, Webster NR. Matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1 and tumour necrosis factor alpha release during cardiopulmonary bypass. Anaesthesia2002;57:659–62.10.1046/j.1365-2044.2002.02625.xSearch in Google Scholar
30. Biglioli P, Cannata A, Alamanni F, Naliato M, Porqueddu M, Zanobini M, et al. Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress. Eur J Cardiothorac Surg2003;24:260–9.10.1016/S1010-7940(03)00295-1Search in Google Scholar
©2007 by Walter de Gruyter Berlin New York
