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[Changes of selected immunological parameters after cardiopulmonary bypass in postop period]
L Bystryk1, T Hirnle, R Sciborski
1Katedry i Kliniki Chirurgii Serca AM we Wrocławiu.
Insights
Postoperative organ failure after cardiopulmonary bypass is linked to lower C3 and C4 complement levels. Higher C3 and C4 levels correlate with shorter intubation times, indicating improved recovery.
Area of Science:
- Immunology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) surgery can trigger significant immunological responses.
- Understanding these immune changes is crucial for optimizing patient recovery and outcomes.
Purpose of the Study:
- To investigate the relationship between specific immunological parameters and the postoperative course in patients undergoing CPB.
- To determine if complement components C3, C4, and immunoglobulins (IgA, IgG, IgM) predict extubation time and organ failure.
Main Methods:
- Blood samples were collected from 70 CPB patients at six time points (pre-op to 14 days post-op).
- Levels of complement components C3, C4, and immunoglobulins IgA, IgG, IgM were measured.
- Patients were analyzed based on extubation timing and occurrence of postoperative organ failure.
Main Results:
- Higher C3 levels (up to 7 days) and C4 levels (1 day post-op) were associated with shorter intubation times.
- Lower C3 levels (up to 3 days) and C4 levels (1 day post-op) were linked to increased postoperative organ failure.
- Postoperative changes in IgA, IgG, and IgM levels did not differ significantly between complicated and uncomplicated recovery groups.
Conclusions:
- Complement components C3 and C4 play a role in predicting extubation time and the risk of organ failure after CPB.
- Monitoring C3 and C4 levels may help identify high-risk patients for closer postoperative management.
- Immunoglobulin levels showed no significant predictive value for postoperative complications in this study.
Abstract:
The aim of the study was to evaluate the influence of changes of chosen immunological parameters on postoperative course patients after cardiopulmonary bypass operation. Complement components C3, C4 and immunoglobulins IgA, IgG, IgM were taken into account. The group consisted of 70 patients, 51 men at mean age 52.6 +/- 10.8 years and 19 women at mean age 50.7 +/- 11.0 years. All patients were operated in moderate hypothermia 26-32 degrees C with use of crystalloid cardioplegia. We used membrane oxygenators: Safe II (Polystan), Monolyth (Sorin), Maxima (Medtronic) and Bentley (Baxter). In 36 patients with multivessel coronary artery disease the internal thoracic artery and saphena vein grafts were performed. 27 patients underwent the valve prosthesis implantation procedure and 7 correction of the congenital heart dis-ease. The mean extracorporeal perfusion time was 127.5 +/- 51.0 min. The mean aortic cross-clamping time was 65.6 +/- 26.9 min. 6 blood samples were taken in the time periods called from 0 to 5: 0--before the operation, 1--right after the operation, 2--1 day after the operation, 3--3 days after the operation, 4--7 days after the operation, 5--14 days after the operation. All the immunological parameters were measured at the Technicon RA-1000 System device using plasma antibody serum of Behring Company. We compared two groups: 1) 21 patients extubated at operation day with 42 patients extubated at 1-th postoperative day, 2) 38 patients with postoperative organ failure with 32 patients without organ complications. The intubation time was shorter in patients with higher levels of C3 (to 7-th day) and C4 (at 1-th postoperative day). The postoperative organ failure were more frequently in patients with lower postoperative C3 (to 3-th day) and with lower C4 at 1-th postoperative day. The postoperative changes of immunoglobulins IgA, IgG, IgM were similar in patients with complicated and uncomplicated postoperative course.
