Introduction (2)

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However, it is conceived that reperfusion results in endothelial damage, free radical production, complement and thrombocyte activation, and cytokine release, which ultimately result in an inflammatory reaction. Release of pro-inflammatory cytokines from the myocardium induced by MIRI is not limited to the organ itself but also contributes to activation of systemic vascular endothelium, clinically recognized as SIRS.

Patients with preexisting heart failure seem to develop complications related to the systemic inflammatory response more often after cardiac surgery than non-heart failure patients. Those with preexisting heart failure show more often a marked temporary reduction in the post-operative pump function, have a higher release of systemic pro-inflammatory cytokines and experience a prolonged stay in ICU due to post-operative complications. These observations suggest attribution of MIRI and a systemic inflammatory response to the impaired outcome for heart failure patients after cardiac surgery. Suppression of the responses initiated by MIRI has been suggested as therapeutic to improve cardiac surgery outcome.

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