Preoperative Oral Pentoxifylline for Management of Cytokine Reactions in Cardiac Surgery
DOI:
https://doi.org/10.1532/HSF98.20081153Abstract
Background: Cardiopulmonary bypass may lead to many inflammatory responses that may cause myocardial dysfunction after open heart surgery. We aimed to investigate the effect of preoperative pentoxifylline treatment to reduce the occurrence of cardiopulmonary bypass-induced inflammatory response.
Methods: In a prospective, randomized study, 40 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (study group, n = 21) or not (control group, n = 19). Pretreatment with pentoxifylline (800 mg/day orally) was started 5 days before the operation. Blood samples for measurements of tumor necrosis factor (TNF)-?, interleukin (IL)-6, IL-8 from the arterial line, and venous blood samples for creatine kinase (CK) and CK isoenzyme fraction MB (CK-MB) were taken in both groups at 5 different time points. Hemodynamic parameters were measured with the thermodilution technique.
Results: TNF-?, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a greater increase in the control group (P < .05). There were no significant differences between the groups for the values of CK-MB and hemodynamic parameters.
Conclusions: We conclude that pretreatment with oral pentoxifylline before cardiac surgery inhibits proinflammatory cytokine release caused by cardiopulmonary bypass and has some beneficial effects in protecting the myocardium during the cardioplegic arrest period in open-heart surgery, without affecting postoperative hemodynamics.
References
Aleshin A, Sawa Y, Ono M, Funatsu T. 2004. Myocardial protective effect of FR167653; a novel cytokine inhibitor in ischemic-reperfused rat heart. Eur J Cardiothorac Surg 26:974-80.nBittar MN, Carey JA, Barnard JB, Pravica V, Deiraniya AK, Yonan N, Hutchinson IV. 2006. Tumor necrosis factor alpha influences the inflammatory response after coronary surgery. Ann Thorac Surg 81:132-7.nCzerny M, Baumer H, Kilo J, et al. 2000. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg 17:737-42.nEdmunds LH Jr. Extracorporeal perfusion. 1997. In: Edmunds LH Jr, editor. Cardiac surgery in the adult., New York: McGraw-Hill. p. 255-94.nEdmunds NJ, Lal H, Woodward B. 1999. Effects of tumour necrosis factor-alpha on left ventricular function in the rat isolated perfused heart: possible mechanisms for a decline in cardiac function. Br J Pharmacol 126:189-96.nEl Azab SR, Rosseel PM, de Lange JJ, et al. 2002. Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery. Br J Anaesth 88:496-501.nFrangogiannis NG, Smith CW, Entman ML. 2002. The inflammatory response in myocardial infarction. Cardiovasc Res 53:31-47.nGessler P, Pfenninger J, Pfammatter JP, Carrel T. 2003. Plasma levels of interleukin-8 and expression of interleukin-8 receptors on circulating neutrophils and monocytes after cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 126:718-25.nGiomarelli P, Scolletta S, Borrelli E, Biagioli B. 2003. Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10. Ann Thorac Surg 76:117-23.nHeinze H, Rosemann C, Weber C, et al. 2007. A single prophylactic dose of pentoxifylline reduces high dependency unit time in cardiac surgery: a prospective randomized and controlled study. Eur J Cardiothorac Surg 32:83-9.nIskesen I, Saribulbul O, Cerrahoglu M, Onur E, Destan B, Sirin BH. 2006. Pentoxifylline affects cytokine reaction in cardiopulmonary bypass. Heart Surg Forum 9:E883-7.nJi Q, Zhang L, Jia H, Xu J. 2004. Pentoxifylline inhibits endotoxin-induced NF-kappa B activation and associated production of proinflammatory cytokines. Ann Clin Lab Sci 34:427-36.nLaffey JG, Boylan JF, Cheng DC. 2002. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 97:215-52.nLarmann J, Theilmeier G. 2004. Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery. Best Pract Res Clin Anaesthesiol 18:425-38.nMiller BE, Levy JH. 1997. The inflammatory response to cardiopulmonary bypass. J Cardiothorac Vasc Anesth 11:355-66.nSzefner J. 1995. Control and treatment of hemostasis in cardiovascular surgery. The experience of La Pitie hospital with patients on total artificial heart. Int J Artif Organs 18:633-48.nTsang GM, Allen S, Pagano D. 1996. Pentoxifylline preloading reduces endothelial injury and permeability in cardiopulmonary bypass. Asaio J 42:429-34.nUstunsoy H, Sivrikoz MC, Tarakcioglu M, Bakir K. 2006. The effects of pentoxifylline on the myocardial inflammation and ischemia-reperfusion injury during cardiopulmonary bypass. J Card Surg 21:57-61.nWan S, LeClerc JL, Vincent JL. 1997. Inflammatory response to cardiopulmonary bypass. Chest 112:676-93.n
