The effect of open heart valve surgery under cardiopulmonary bypass on myocardial inflammatory response

ZHOU Tao; HE Wei

doi:10.3969/j.issn.1672-5301.2018.01.013

Abstract：Objective To study the effect of open heart valve surgery under cardiopulmonary bypass (CPB) on myocardial inflammatory response.Methods Forty patients undergoing elective artificial mechanical heart valve replacements with CPB were randomly divided into conventional group and beating heart group,20 cases in each group.While the conventional approach was used for 20 patients in the conventional group,the heart was kept empty and beating throughout the operation in the beating heart group.In all patients,blood samples withdrawn at (T1)before CPB,(T2)30 min after CPB commencement,(T3) when the right atrium was closed,(T4)24 h,(T5)72 h,and (T6)120 h after weaning from CPB were assayed for cardiac troponin Ⅰ (cTnI) and CK-MB.Meanwhile,right atrial myocardial tissue samples were taken to detect myocardial interleukin (IL)-6,IL-8,IL-10,and tumor necrosis factor-alpha (TNF-α) concentrations when the right atrium was opened and closed.Results Compared to the conventional group,the increasing degrees of cTnI and CK-MB were significantly lower in the beating heart group from T3 to T5 [cTnI:(2.51 ±0.35)μg/L,(3.77±0.30) μg/L,(0.12±0.03) μg/L vs.(6.55 ±0.48)μg/L,(7.08 ±0.41) μg/L,(4.47 ±0.53)pg/L;CK-MB:(0.55 ±0.09)μkat/L,(0.67 ±0.11)μkat/L,(0.38±0.09) μkat/L vs.(0.68±0.11)μkat/L,(0.84±0.12)μkat/L and(0.74±0.13)μ kat/L,P＜0.05].The elevated levels of TNF-α,IL-6,IL-8 were lower in beating heart group than conventional group.Conclusion The study illustrate that decreased myocardial inflammatory reaction is associated with myocardial protection by the beating heart valve replacement with mild hypothermia.