Postpericardiotomy syndrome: the role of genetic factors in the pathogenesis of a systemic inflammatory response after open-heart surgery

Aim. To assess the predictive value of polymorphic variants analyzing of interleukin-6  (IL-6)  gene  in patients  with postpericardiotomy  syndrome  (PPS) during open-heart surgery.

Material and methods. The study included 200 patients. All patients were analyzed for acute  phase   parameters in serum,  effusion  fluid and  region  of IL-6  gene promoter sequence.

Results. When analyzing the effusion fluid, in 15% of patients  with early PPS,  in accordance with the Light RW criteria, transudate was detected. Application of the Roth  BJ  criteria  increased this  proportion  to  32%.  An increase   in the  level of C-reactive  protein  (CRP), procalcitonin,  and  adenosine deaminase (ADA) activity indicated a systemic inflammatory response. The viral genome of cardiotropic viruses was detected in the effusion fluid in 10-12% of patients with PPS. Scanning mutations in the IL-6 500 bp region revealed one polymorphism of -174G>C. The frequency ofPPS  in patients  with different  genotypes (-174GC,  -174GG and  -174CC)  did not significantly differ. An association of the -174GG genotype of the IL-6 gene with a high risk of developing systemic inflammation in open-heart surgery and more frequent postoperative infectious complications has been established. In addition, the -174GG genotype was more often detected in patients with late PPS (p=0,017). There was nocorrelation between  the occurrence of genotypes, as well as the distribution of IL-6 gene  and coronary  obstruction  index. However, carriage  of the G allele was more often detected in patients with injury of left main coronary artery.

Conclusion. The presence of the -174GG genotype of the IL-6 gene and cardiotropic viruses contribute to the systemic inflammation during cardiosurgical interventions in extracorporeal circulation, but do not have predictive value for the PPS development.

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