MINERVA MEDICA COPYRIGHT ® J CARDIOVASC SURG 2008;49:801-8 The systemic inflammatory response in coronary artery bypass grafting: what is the role of the very low ejection fraction (EF ≤30%)? E. A KARFIS 1, 2 , G. PAPADOPOULOS 3 , M. MATSAGAS 4 , D. PANTAZI 5 , M. LEKKA 5 , I. KITSIOULI 5 , S. SIMINELAKIS 1 , C. ANAGNOSTOPOULOS 6 , G. DROSSOS 2 Aim. Patients with depressed left ventricular function are more susceptible to develop postoperative compli- cations after cardiac surgery. The aim of the present study was to examine the effect of severe left ventricu- lar dysfunction on the activation of systemic inflam- matory reaction during and after coronary artery bypass grafting (CABG). Methods. Clinical prospective study; 32 selected patients underwent CABG; 16 patients had depressed left ven- tricular function before the operation (low ejection frac- tion [EF] <30%) – Low EF group (study group). Sixteen patients had normal left ventricular function (normal EF, >50%) – Normal EF group (control group). The levels of inflammatory mediators TNF-α, IL-6, IL-8 and IL-10 were measured preoperatively, during and after car- diopulmonary bypass (CPB) and 24 hours postopera- tively. Results. Higher levels of almost all of inflammatory mediators were detected in patients with depressed left ventricular function compared with patients of normal EF group. IL-6 levels were found statistically significant higher in Low EF group before the induction of anes- thesia (P=0.039) and after the administration of prota- mine (P=0.02). IL-8 levels were found statistically sig- nificant higher in Low EF group before the induction of anesthesia (P=0.05), 30 min after the start of CPB (P=0.02), after the administration of protamine (P=0.015) and 24 hours after the end of the operation (P=0.05). No statistically significant differences were demon- strated between the 2 groups of study relative to TNF-α and IL-10. Conclusion. A greater activation of systemic inflamma- 1 Department of Cardiac and Thoracic Surgery University Hospital of Ioannina School of Medicine, Ioannina, Greece 2 Department of Cardiac and Thoracic Surgery G. Papanikolaou General Hospital, Thessaloniki, Greece 3 Department of Anesthesia University Hospital of Ioannina School of Medicine, Ioannina, Greece 4 Department of Surgery-Vascular Surgery Unit University Hospital of Ioannina School of Medicine, Ioannina, Greece 5 Institute of Biochemistry, Department of Chemistry University of Ioannina, Ioannina, Greece 6 College of Physicians and Surgeons of Columbia University, New York, NY, USA tory reaction occurred in patients with depressed left ventricular function than in patients with normal cardiac function when they underwent CABG with extracorpo- real circulation. KEY WORDS: Coronary artery bypass - Cytokines - Tumor necro- sis factor-alpha. H eart operations with cardiopulmonary bypass (CPB) are associated with a transient inflamma- tory response involving the release of proinflamma- tory and antiinflammatory cytokines. 1-4 Both surgical trauma and CPB contribute to the inflammatory response after cardiac surgery. 5 CPB, extracorporeal membrane oxygenation, ischemia-reperfusion injury and hypothermia induce systemic inflammatory response, which is characterized by the activation of chemotactic factors, oxygen free radicals, comple- ment, neutrophils, endotoxins, elastases and cyto- kines. 1, 2 This so called post pump inflammatory Fundings.—No financial or other potential conflicts of interest exist. Acknowledgments.—The authors thank Mrs. Aphrodite Katsaraki, BSc, for her excellent scientific assistance in preparing the statistical analysis of this study. Received on March 3, 2008. Accepted for publication on October 14, 2008. Corresponding author: E. A. Karfis, MD, PhD, 11, Kiouptsidou, GR- 55133, Thessaloniki, Greece. E-mail: hkarfis@yahoo.gr Vol. 49 - No. 6 THE JOURNAL OF CARDIOVASCULAR SURGERY 801