Development of C-reactive Protein and Fibronectin Levels in Coronary Surgery PatientsA Comparison of On-pump, Off-pump Sternotomy and Off-pump Left Anterior Small Thoracotomy Groups

摘要

In this prospective study, we monitored two laboratory parameters, C-reactive protein (CRP) and fibronectin (FIN) levels, in 30 patients undergoing elective surgery for ischemic heart disease. These patients were divided into three groups according to the surgical procedure used: group A, approach through a median sternotomy with the use of extracorporeal circulation; group B, approach through a median sternotomy without the use of extracorporeal circulation; and group C, approach through a left anterior small thoracotomy (LAST) without the use of extracorporeal circulation. Peak CRP levels were found in all three groups on the second postoperative day, with the mean levels being statistically significantly higher in group C. This group also showed the highest mean CRP levels on the third and fourth postoperative days, with the difference being statistically nonsignificant. These findings can be explained by an enhanced production of cytokines, which in turn trigger CRP synthesis, induced by postoperative pain due to the LAST procedure. No statistically significant correlation between preoperative CRP levels and their postoperative development was found. None of the groups studied showed any statistically significant decrease in FIN plasma levels, either prior to adjustment for hemodilution or after adjustment for hematocrit and serum albumin.