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  • Meeting abstract
  • Open Access

The cardiopulmonary bypass supported high-risk PTCA (CPB-PTCA): a useful model for the study of CPB-dependent systemic inflammatory response syndrome (SIRS)?

  • 1,
  • 1,
  • 2,
  • 3,
  • 4,
  • 5,
  • 5,
  • 5,
  • 4,
  • 2 and
  • 1
Critical Care19971 (Suppl 1) :P033

https://doi.org/10.1186/cc39

  • Published:

Keywords

  • Public Health
  • Inflammatory Response
  • Plasma Level
  • Ejection Fraction
  • Emergency Medicine

The mechanisms underlying myocardial depression following open heart surgery with extracorporeal circulation is still a matter of debate. One important trigger mechanism responsible for myocardial depression seems to be related to the release of cytokines during the systemic inflammatory response. Aim of the present study was to investigate whether CPB supported PTCA might be a useful model for the differentiation of surgery-dependent and CPB-SIRS-induced myocardial depression.

Methods

PTCA supported angioplasty with CPB; transesophageal echocardiography; wall motion score (WMS); plasma levels of cytokines and parameters as shown in the table. Seven patients, mean age 61.3 years, ejection fraction, 17–64%: five patients with three-vessel-CAD; two patients with two-vessel-CAD: four patients with CABG. (I) Before CPB: (II) beginning CPB: (III) immediately before PTCA; (IV) end CPB.

Results

See table.

Summary

CPB-PTCA helps to discriminate between surgery-induced and CBP-dependent systemic inflammatory response syndrome.

Table 1

 

I

II

III

IV

n

MAP

93.3 ± 24.7

59.3 ± 6.2

60.3 ± 7.5

71.0 ± 16.0

5

HR

89.3 ± 30.5

81.5 ± 3.5

82.0 ± 14.4

105.3 ± 23.5

4

CVP

12.8 ± 2.9

12.3 ± 1.0

15.0 ± 6.1

17.0 ± 6.8

5

cSVR

771.3 ± 312.8

691.8 ± 172.4

748.3 ± 167.7

635.3 ± 975.9

5

Total flow*

3.0 ± 0.9

2.9 ± 0.7

2.4 ± 1.0

2.0 ± 0.7

4

WMS

1.9 ± 0.4

2.3 ± 0.5

2.1 ± 0.2

2.2 ± 0.3

3

APACHE II-score on day 1 and after PTCA: 11.4 ± 2.1 versus 14.9 ± 6.4 (n = 7)

Table 2

 

At the start

After 5 h

n

TNF-α

8.3 ± 6.2 pg/ml

20.1 ± 19.0 pg/ml

4

TNF R p55

2.0 ± 0.4 ng/ml

3.1 ± 0.3 ng/ml

4

TNF R p75

2.5± 1.3 ng/ml

5.1± 1.6 ng/ml

4

IL-6

10.6± 4.4 pg/ml

98.5± 54 pg/ml

4

Endotoxin

0.5± 0.2 EU/ml

0.3± 0.1 EU/ml

2

*Total flow = cardiac index and CPB-flow mean ± SD.

Authors’ Affiliations

(1)
Lehrstuhl für Kardiologische Intensiemedisin, Germany
(2)
Klinik für Innere Medizin III, Germany
(3)
Klinik für Anästhesiologie and Operative Intensiemedisin, Germany
(4)
Klinik für Hers- und Thorax-chirurgie, Klinikum Kröllwits, Marin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str-40, 06097 Halle, Germany
(5)
Institut für Klinische Chemie, Klinikum Groβhadern, Ludwig-Maximilians-Universität München, Marchionistr 15, 81377 Munchen, Germany

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