Cardiovascular Journal of Africa: Vol 28 No 6 (November/December 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018 22 AFRICA
Effects of age on systemic inflammatory response
syndrome and results of coronary bypass surgery
Orhan Gokalp, Nihan Karakas Yesilkaya, Sahin Bozok, Yuksel Besir, Hasan Iner, Huseyin Durmaz,
Yasar Gokkurt, Banu Lafci, Gamze Gokalp, Levent Yilik, Ali Gurbuz
Abstract
Background: Coronary artery bypass (CAB) surgery triggers
systemic inflammatory response syndrome (SIRS) via several
mechanisms. Moreover, age is directly correlated with SIRS.
We evaluated the effect of age on SIRS and postoperative
outcome after CAB surgery.
Methods: We retrospectively reviewed the records of 229
patients who had undergone CAB surgery. The patients were
divided into three groups according to age: group 1, < 40 years
( n = 61); group 2, 40–75 years (n = 83); and group 3, > 75
years old ( n = 85). Pre- and peri-operative data were assessed
in all patients. SIRS was diagnosed according to the criteria
established by Boehme.
Results: The average pre-operative EuroSCORE value in
group 3 was higher than in the other groups and body surface
areas were significantly lower in group 3 than in the other
groups ( p < 0.05). The postoperative SIRS rates were 68.9%
in group 1, 84.3% in group 2 and 91.8% in group 3 (group 1
vs group 3; p < 0.05). Mortality rates were not significantly
different between the groups (p > 0.05). The predictive factors
for SIRS were age, EuroSCORE rate, on-pump CAB surgery
and intra-aortic balloon pump use.
Conclusion: Age was an important risk factor for SIRS during
the postoperative period after CAB.
Keywords: systemic, inflammation, coronary, bypass
Submitted 21/3/17, accepted 16/5/17
Published online 23/5/17
Cardiovasc J Afr 2018; 29: 22–25
DOI: 10.5830/CVJA-2017-030
Coronary artery bypass grafting (CABG) is the conventional
treatment for coronary artery disease (CAD). Previously, CABG
was primarily performed in patients between the ages of 60 and
75 years. However, because of increased life expectancy and the
need to re-perform the procedure, CABG is now commonly
performed in patients over 75 years of age.1–3 As a result of
this age-related shift in CABG recipients, some postoperative
outcome parameters have changed.
Systemic inflammatory response syndrome (SIRS) is an
inflammatory process that can be triggered during open-
heart surgery. SIRS is produced by the release of several
pro-inflammatory mediators and affects postoperative outcome
after open-heart surgery.3,4 The recent marked increase in SIRS
after CABG may be due to age-related changes in the immune
system.5,6 We therefore investigated the correlation between age
and SIRS after CABG.
Methods
Ethics committee approval was obtained for the study. Patient
medical records were obtained from the hospital automation
system and archived files.
We retrospectively evaluated 229 patients who had undergone
CABG. The patients were divided into three groups according
to age: group 1 patients were under 40 years old (n = 61), group
2 were 40–75 years (n = 83), and group 3 were over 75 years old
( n = 85).
We compared the incidence of SIRS and several clinical
parameters among the groups. SIRS was diagnosed by the
criteria used by Boehme.7 According to these criteria, the
existence of two of the following symptoms was sufficient for
the diagnosis of SIRS: fever < 36°C or > 38°C, heart rate >
90 beats/min, respiratory rate > 20 breaths/min or PaCO2 < 32
mmHg, leukocytes < 4 000 cells/μl or > 12 000 cells/μl or > 10%
polymorphonuclear leukocytes for at least 24 hours. All patients
were cooled to 32°C during cardiopulmonary bypass (CPB).
Patients who underwent emergent CABG or simultaneous
valve/vascular surgery were excluded from the study. In addition,
patients given postoperative anti-inflammatory drugs were also
excluded from the study.
Statistical analysis
All of the statistical tests were conducted using the Statistical
Package for the Social Sciences for Windows version 22 (SPSS
Department of Cardiovascular Surgery, Faculty of
Medicine, İzmir Katip Celebi University, İzmir, Turkey
Orhan Gokalp, MD
Yuksel Besir, MD
Levent Yilik, MD
Ali Gurbuz, MD
Department of Cardiovascular Surgery, Ataturk Training
and Research Hospital, İzmir Katip Celebi University, İzmir,
Turkey
Nihan Karakas Yesilkaya, MD
Hasan Iner, MD
Huseyin Durmaz, MD
Yasar Gokkurt, MD
Banu Lafci, MD
Department of Cardiovascular Surgery, Bahcesehir
University, İstanbul, Turkey
Sahin Bozok, MD,
Department of Pediatric Emergency, İzmir Tepecik Training
and Research Hospital, İzmir, Turkey
Gamze Gokalp, MD