Objective: Cardiopulmonary bypass (CPB) has long been recognized as one of the major causes of a complex systemic inflammatory response, which may contribute to postoperative complications. Recent investigations have indicated that high levels of circulating cell free DNA (CFD) (>875 ng/ml), an integrative marker of tissue damage, have been associated with poor prognosis in various diseases. We aimed to analyze alterations in serum CFD levels during cardiopulmonary bypass (CPB), correlation with known risk factors, standard markers, short and long term complications.
Methods: Seventy-four patients undergoing elective coronary bypass grafting with CPB were enrolled in this study. Blood samples withdrawn at (T1) prior to skin incision, (T2) 20 minutes after CPB start, (T3) 40 minutes after CPB start, (T4) immediately after cross clamp removal , (T5) 30 minutes after sternal closure were assayed for CFD.
Results: A cumulative gradual increase in CFD levels during CPB was found: before skin incision (T1) mean 1249.51ng/ml, peak immediately after cross clamp removal (T4) mean 3742.9ng/ml and back to the level before the operation (T5) 30 minutes after sternal closure. The peak level of CFD was higher as the duration of CPB was longer (P<0.05; mean x clamp time 66.58±27.69min, mean CPB time 71.48 ± 26.63). Induction of CFD was concomitant with the change in creatinine phosphokinase (CPK) levels. No correlation was found between CFD levels and short or long term complications.
Conclusions: Serum CFD is significantly induced in cardiac surgery using CPB and concomitant with induction of CPK. Despite this significant increase the fast recovery of CFD levels indicates limited and temporary deleterious effects of short-duration CPB.
