Influence of dextran-70 on systemic inflammatory response and myocardial ischaemia-reperfusion following cardiac operations

Abstract

Introduction: Experimental studies have demonstrated that dextran-70 reduces the leukocyte-endothelium interaction, but clinical evidence is still lacking. Our objective was to justify the anti-inflammatory effect of dextran-70 following cardiac operations.

Methods: Forty patients undergoing coronary bypass surgery (n = 32) or aortic valve replacement (n = 8) were enrolled in this prospective, randomized, double-blind study. Two groups were formed. In group A (n = 20), dextran-70 infusion was administered at a dose of 7.5 ml/kg before the initiation of cardiopulmonary bypass and at a dose of 12.5 ml/kg after the cessation of cardiopulmonary bypass. Group B served as a control with identical amounts of gelatin infusion (n = 20). The plasma concentration of procalcitonin, C-reactive protein, IL 6, IL 6r, IL 8, IL 10, soluble endothelial leukocyte adhesion molecule-1, soluble intercellular adhesion molecule-1, cardiac troponin-I and various haemodynamic parameters were measured in the perioperative period. Multivariate methods were used for statistical analysis.

Results: In group A, lower peak (median) plasma levels of procalcitonin (0.2 versus 1.4, p < 0.001), IL 8 (5.6 versus 94.8, p < 0.001), IL 10 (47.2 versus 209.7, p = 0.001), endothelial leukocyte adhesion molecule-1 (88.5 versus 130.6, p = 0.033), intercellular adhesion molecule-1 (806.7 versus 1,375.7, P = 0.001) and troponin-I (0.22 versus 0.66, p = 0.018) were found. There was no significant difference in IL 6, IL-6r and C-reactive protein values between groups. Higher figures of the cardiac index (p = 0.010) along with reduced systemic vascular resistance (p = 0.005) were noted in group A.

Conclusion: Our investigation demonstrated that the use of dextran-70 reduces the systemic inflammatory response and cardiac troponin-I release following cardiac operation.

Trial registration number: ISRCTN38289094.

Figure 1

Procalcitonin plasma levels before operation and 24 hours after cardiopulmonary bypass. Procalcitonin (PCT) plasma levels in the treated and control groups, before operation (t1) and 24 hours after cardiopulmonary bypass (t5). Significant elevation was found in both groups (*Friedman tests). After the operation, procalcitonin was lower in group A. The between-group difference was significant (⁺ Kruskal–Wallis test).

Figure 2

IL-8 plasma levels before operation and after cardiopulmonary bypass. IL-8 plasma levels in the treated and control groups, before operation (t1) and 10 minutes (t2) and 2 hours (t3) after cardiopulmonary bypass. Significant elevation was found in both groups (*Friedman tests). At t2 and t3 the IL-8 plasma levels were lower in group A. The between-group differences were significant (⁺Kruskal–Wallis test).

Figure 3

Soluble intercellular adhesion molecule 1 plasma levels before operation and after cardiopulmonary bypass. Soluble intercellular adhesion molecule 1 (ICAM-1) plasma levels in the treated and control groups, before operation (t1) and 24 hours (t5) and 44 hours (t6) after cardiopulmonary bypass. No elevation was found in group A, but the elevation was significant in group B (*Friedman tests). The between-group differences were significant after cardiac surgery on cardiopulmonary bypass (⁺Kruskal–Wallis test).