Characterization of lymphocyte subpopulations and cardiovascular markers in pericardial fluid of cardiac surgery patients.

BACKGROUND: Composition of pericardial fluid (PF) may reveal immunological processes influencing oxidative stress and microcirculation of different tissues of the heart and may play a role in the course of myocardial infarction, atherosclerosis, and aortic stenosis. PATIENTS AND METHODS: We investigated lymphocyte populations, cardiovascular markers and immunoglobulin composition in PF and blood samples of patients undergoing CABG operation and compared them to those who had aortic valve surgery. RESULTS: The amount of CD8 + T, NK, memoT and activated T-cytotoxic cells were elevated in PF compared to blood, but naiveT and activated T-helper cell ratio were lower in PF. Amount of activated T-helper cells and regulatory T-lymphocytes were elevated in CABG participants in both PF and blood. INKT cells represented the only regulatory lymphocyte population reaching significantly higher concentration in PF than in blood. IL-6 and MCP1 level were elevated in PF compared to blood and MCP1 plasma level was markedly elevated in CABG group. CONCLUSIONS: Our study describes a comprehensive immunological analysis of PF in humans for the first time. We showed that the investigated lymphocyte populations and cardiovascular markers in PF have significantly different distribution compared to blood, and lymphocyte populations show different compartmentization in coronary disease and aortic stenosis.

Five-Year Outcome after Coronary Artery Bypass Surgery in Survivors of Out-of-Hospital Cardiac Arrest.

OBJECTIVE: The aim of this study was to evaluate the role of coronary artery bypass grafting (CABG) in patients with out-of-hospital cardiac arrest (OHCA). METHODS: The immediate and 5-year outcome after CABG of a consecutive series of 48 patients who survived OHCA was compared with those of control patients having had a recent myocardial infarction without ventricular arrhythmias. RESULTS: All OHCA patients were found to have suffered myocardial infarction-related cardiac arrest. The mean delay from OHCA to CABG was 10.3 ± 13.0 days. Despite not statistically significant, the risk of 30-day postoperative mortality was higher among OHCA patients than control patients (6.3 vs. 0%, p = 0.24, propensity score adjusted analysis: p = 1.00). Cardioverter defibrillator was implanted in two patients who were alive 3.8 and 4.4 years after CABG, respectively. At 5-year, the overall survival rate was 80.7% in OHCA patients and 84.5% in control patients (p = 0.98, propensity score adjusted analysis: p = 0.87), and survival freedom from fatal cardiac event was 86.1% in OHCA patients and 86.5% in control patients (p = 0.61; propensity score adjusted analysis: p = 0.90). CONCLUSIONS: Early and 5-year survival rates after CABG in OHCA patients are excellent even when cardioverter defibrillator is very selectively implanted. The early and intermediate results CABG suggest a confident approach toward surgical revascularization in this critically ill patient population.