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Detection of circulating tumour necrosis factor-α after elective cardiopulmonary bypass

Plasma samples for the assay of tumour necrosis factor-a (TNF) were obtained prior to operation, during perfusion and at hourly intervals during the first 24 hours after operation from five consecutive patients undergoing elective coronary artery bypass grafting. TNF was detected in high concentration (>10 000pg/ml) in one patient and in low levels (approximately 1 00pg/ml) in two other patients during the first 1-6 hours after removal of the aortic crossclamp at the end of perfusion. All other samples were negative. The results support the hypothesis that TNF is transiently released as a response to the endotoxaemia known to occur towards the end of bypass. The significance of these findings in relation to the development of adult respiratory distress syndrome and multiple organ failure in unstable patients undergoing open-heart surgery is discussed briefly.