RESUMEN
Cardiopulmonary bypass [CPB] exposes blood to large areas of synthetic materials that trigger the production and release of numerous ehemotactic and vasoactive substances. This ensuing abnormal whole-body inflammatory response that can complicate the postoperative period. This prospective randomized controlled study aimed to assess the concept of cytokine balance in the early period after CPB. Twenty adult patients subjected for open heart surgery for valve replacement or repair were included, surgical approach, anesthetic regimen, CPB protocol, monitoring and ICU care were standardized for all the patients. Laboratory investigations included differential leukocytic count changes, pro-inflammatory mediators; TNF-alpha IL-6, and IL-8, and anti-inflammatory mediator IL-10. The values were determined prebypass, at end of CPB, twelve and twenty four hours after end of bypass. There were significant changes in total and differential leukocytic counts after bypass. The total leukocytic count and absolute neutrophilic count increased significantly after bypass and steadily increasing parallel to each other after twelve and twenty four hours after bypass accompanied by significant decrease in the relative count of lymphocytes and monocytes. Serum levels of TNF-alpha, IL-6, IL-8 and IL-10 significantly increased at the end of bypass and after twelve hours compared with the prebypass levels, this increase was small but statistically significant compared to the prebypass levels with TNF-alpha and IL-8, at twelve and twenty four hours, the increase in IL-6 was more prominent and lasted for the 24 hours study period compared to that of IL-10 which showed a peak value immediately after CPB. Twenty four hours after the end of bypass the serum levels of TNF-alpha, IL-8 and IL-10 decreased but still significantly higher than the prebypass levels. Serum level of IL-6 remained significantly high. CPB is followed by both pro- and anti-inflammatory changes in the early 24 hours post-operatively. Marked leukocytic changes and increased serum levels of TNF-alpha, IL-6, IL-8 and IL-10 were observed