What is the Role of Different Cardioplegic Solutions in the Perioperative Immune Response During Cardiac Surgery?

Background: The extent of the immune response following cardiac surgery with cardiopulmonary bypass (CPB) has been successfully correlated with the incidence of postoperative complications. We tested the hypothesis that surgical trauma is the main factor determining the perioperative immune response and that, therefore, the use of different cardioplegic solutions, as previously discussed, did not influence the perioperative immune response.

Methods: 430 patients who underwent uncomplicated elective cardiac surgery were included retrospectively. (Bretschneider’s-solution (HTK) n=118; St.Thomas’-solution (ST) n=137; blood cardioplegia (BC) n=175). Serum levels of interleukin (IL)-6, IL-8, tumour necrosis factor (TNF)-alpha, , IL-10, and acute phase proteins, (i.e. C-reactive protein or CRP), lipoprotein-binding protein (LBP) and procalcitonin (PCT) were assayed preoperatively (d0), immediately (dx), 6 and 12 hours (dx+6, dx+12), and on the 1st (d1), 3rd (d3) and 5th (d5) day after surgery.

Results: An intergroup comparison of IL-6, IL-8, TNF-alpha, CRP, and LBP levels revealed no differences. All parameters increased postoperatively and remained elevated until d5. CRP and LBP peaked at d3 and remained elevated until d5. IL-10 levels increased to a maximum at dx and stayed elevated until d1. PCT serum levels increased postoperatively with a peak at d1. We documented higher levels for both parameters in the HTK group compared to BC patients. ST patients showed the lowest levels of these mediators.

Conclusions: The use of different cardioplegic solutions caused only minor clinical or immunological differences. We can therefore conclude that the extent of surgical trauma is the main factor influencing the release of pro-inflammatory cytokines and the subsequent acute phase response.

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