Abstract
Background and aims: Increased inflammatory activity has been observed in elderly people. The aim of this study was to determine whether cytokine responses after coronary artery bypass grafting (CABG) in elderly patients are different from those in younger patients. Methods: Fifty-five male patients admitted for first-time elective coronary artery bypass surgery were divided into two age groups: group I, patients younger than 70 years (N=40); and group II, patients aged 70 years or older (N=15). Perioperative levels of cytokines and CK-MB were measured. Hemodynamic data were recorded. Results: Marginally higher IL-6 (p=0.048) and IL-8 (p=0.041) levels were observed during the intensive care unit (ICU) stay in the elderly as compared with younger patients. Lower IL-10 levels were detected in the elderly 5 minutes after reperfusion to the myocardium (p<0.05). Although the postoperative hemodynamic change was similar in both groups, the elderly needed vasopressor treatment more often during the ICU stay. This was associated with lower IL-10 levels 5 minutes after reperfusion. Conclusions: The present results show the age-related imbalance of pro- and anti-inflammatory responses after CABG, associated with hemodynamic instability in the elderly.
Similar content being viewed by others
References
Peigh PS, Swartz MT, Vaca KJ, Lohmann DP, Naunheim KS. Effect of advancing age on cost and outcome of coronary artery bypass grafting. Ann Thorac Surg 1994; 58: 1362–6.
Katz NM, Hannan RL, Hopkins RA, Wallace RB. Cardiac operations in patients aged 70 years and over: mortality, length of stay, and hospital charge. Ann Thorac Surg 1995; 60: 96–100.
Paone G, Higgins RS, Havstad SL, Silverman NA. Does age limit the effectiveness of clinical pathways after coronary artery bypass graft surgery? Circulation 1998; 98 (19 Suppl): II41–5.
Montague NT 3rd, Kouchoukos NT, Wilson TA, et al. Morbidity and mortality of coronary bypass grafting in patients 70 years of age and older. Ann Thorac Surg 1985; 39: 552–7.
Finkel MS, Oddis CV, Jacob TD, Watkins SC, Hattler BG, Simmons RL. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science 1992; 257: 387–9.
Mantovani A, Dejana E. Cytokines as communication signals between leukocytes and endothelial cells. Immunol Today 1989; 10: 370–5.
Jansen NJ, van Oeveren W, Gu YJ, van Vliet MH, Eijsman L, Wildevuur CR. Endotoxin release and tumor necrosis factor formation during cardiopulmonary bypass. Ann Thorac Surg 1992; 54: 744–8.
Hiesmayr MJ, Spittler A, Lassnigg A, et al. Alterations in the number of circulating leucocytes, phenotype of monocyte and cytokine production in patients undergoing cardiothoracic surgery. Clin Exp Immunol 1999; 115: 315–23.
Hennein HA, Ebba H, Rodriguez JL, et al. Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization. J Thorac Cardiovasc Surg 1994; 108: 626–35.
Wei M, Kuukasjärvi P, Laurikka J, et al. Cytokine responses in low-risk coronary artery bypass surgery. Int J Angiol 2001; 10: 27–30.
Paganelli R, Scala E, Quinti I, Ansotegui IJ. Humoral immunity in aging. Aging Clin Exp Res 1994; 6: 143–50.
Faro RS, Golden MD, Javid H, et al. Coronary revascularization in septuagenarians. J Thorac Cardiovasc Surg 1983; 86: 616–20.
Berman ND, David TE, Lipton IH, Lenkei SC. Surgical procedures involving cardiopulmonary bypass in patients aged 70 or older. J Am Geriatr Soc 1980; 28: 29–32.
Fernandez J, Chen C, Anolik G, et al. Perioperative risk factors affecting hospital stay and hospital costs in open heart surgery for patients > or = 65 years old. Eur J Cardiothorac Surg 1997; 11: 1133–40.
Roth-Isigkeit A, Schwarzenberger J, v Borstel T, et al. Perioperative cytokine release during coronary artery bypass grafting in patients of different ages. Clin Exp Immunol 1998; 114: 26–32.
te Velthuis H, Jansen PG, Oudemans-van Straaten HM, Sturk A, Eijsman L, Wildevuur CR. Myocardial performance in elderly patients after cardiopulmonary bypass is suppressed by tumor necrosis factor. J Thorac Cardiovasc Surg 1995; 110: 1663–9.
Wei M, Kuukasjärvi P, Laurikka J, et al. Inflammatory cytokines and soluble receptors after coronary artery bypass grafting. Cytokine 2001; 15: 223–8.
Miller BE, Levy JH. The inflammatory response to cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11: 355–66.
Dybdahl B, Wahba A, Lien E, et al. Inflammatory response after open heart surgery: release of heat-shock protein 70 and signaling through toll-like receptor-4. Circulation 2002; 105: 685–90.
Gormley SM, McBride WT, Armstrong MA, et al. Plasma and urinary cytokine homeostasis and renal function during cardiac surgery without cardiopulmonary bypass. Cytokine 2002; 17: 61–5.
Hill GE, Diego RP, Stammers AH, Huffman SM, Pohorecki R. Aprotinin enhances the endogenous release of interleukin-10 after cardiac operations. Ann Thorac Surg 1998; 65: 66–9.
de Waal Malefyt R, Abrams J, Bennett B, Figdor CG, de Vries JE. Interleukin 10(IL-10) inhibits cytokine synthesis by human monocytes: an autoregulatory role of IL-10 produced by monocytes. J Exp Med 1991; 174: 1209–20.
Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med 1996; 24: 1125–8.
Tabardel Y, Duchateau J, Schmartz D, et al. Corticosteroids increase blood interleukin-10 levels during cardiopulmonary bypass in men. Surgery 1996; 119: 76–80.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wei, M., Kuukasjärvi, P., Laurikka, J. et al. Imbalance of pro- and anti-inflammatory cytokine responses in elderly patients after coronary artery bypass grafting. Aging Clin Exp Res 15, 469–474 (2003). https://doi.org/10.1007/BF03327369
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03327369