It was analyzed the dynamics of inflammatory factors in patients with ischemic heart disease in early postoperative period who underwent various techniques of coronary artery bypass grafting (CABG). Seventy-four patients with ischemic heart disease who required CABG were enrolled into study. Patients were divided into 4 groups depending on technique and volume of surgery. The first group consisted of 7 patients after minimally invasive off-pump myocardial revascularization under normothermia without cardiopulmonary bypass (CPB) and cardioplegia. The second group (36 patients) enrolled patients after normothermic off-pump CABG and parallel CPB. The third group had 12 patients who underwent CABG under CPB, hypothermia (28ºС) and pharmaco-cold cardioplegia. The 4 group consisted of 19 patients who were operated for ischemic heart disease and concomitant cardiac disorders (left ventricular postinfarction aneurysm, valve surgery) under CPB, hypothermia (28 ºС) and pharmaco-cold cardioplegia. Levels of tumor necrosis factor, interleukins (IL-6, IL-8, IL-10) were identified using enzyme immunoassay. Blood sampling was performed preoperatively, in 6 hours and in 24 hours after surgery. Patients after CPB and cardioplegia had more severe systemic inflammatory response and debalance between proinflammatory and anti-inflammatory mediators in early postoperative period. It was revealed correlation between inflammatory cytokines and myocardial damage markers in early postoperative period with development of acute heart failure and multiple-organ failure: IL-8 (r=0.45, р=0.01; r=0.55, р=0.001); troponin I (r=0.65, р=0.0001; r=0.67, р=0.0001); МВ-creatine phosphokinase (r=0.58, р=0.0004; r=0.56, р=0.001). It was concluded that patients after CPB and cardioplegia need for prevention and correction of systemic inflammatory response. It will improve myocardial protection, decrease incidence of acute heart failure and other postoperative complications. Minimally invasive myocardial revascularization is preferable in patients with decreased left ventricular systolic function because of improvement of myocardial protection.
