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OBJECTIVE: Previous studies have suggested that women have a less favorable outcome after coronary bypass surgery when compared to men. This study was undertaken to examine the postoperative time course of serum inflammatory markers and anti-inflammatory responses to off pump coronary bypass surgery stratified by gender.
METHODS: The time course of fasting level of tumour necrosis factor-α (TNF-α), interleukin 8 (IL-8), soluble IL-1 type I receptor (sIL-1 RI), soluble IL-1 type II receptor (sIL-1RII), c-reactive protein (CRP), monocyte chemotactic protein-1 (MCP1), Interferon-gamma induced protein (IP-10), vascular endothelial growth factor (VEGF) at baseline on day 0 and at postoperative days 1,2,3,4,5,6,7 was measured on 65 consecutive patients undergoing elective off pump coronary bypass surgery. The exclusion criteria consisted of the use of anti-inflammatory medications, history of inflammatory disease, acute infection, acute myocardial infarction and use of antibiotics within two weeks of surgery.
RESULTS: 11% were female. At baseline TNF-α was higher in women compared to men(p=0.008). At postoperative days 1 and 2 there were no differences in adipokines secretion between the two genders. At postoperative day 3-7 there was significantly higher sIL-1RI (p=0.11, 0.031, 0.041, 0.014, 0.004) and significantly higher value of TNF-α( p= 0.021, 0.003, 0.052, 0.021, 0.052) in the female gender. There was no difference between the two groups in the time course of the serum levels of IL-8, soluble, sIL-1RII, IP-10, CRP, VEGF and MCP1.
CONCLUSIONS: Off pump surgery in females produces significantly higher inflammatory states as compared to males. Both TNFalpha and sIL-1RI production were higher in the female gender.