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[Inflammatory and fibrinolytic activation after coronary artery bypass with extracorporeal circulation]
Mario Gaudino1, Giuseppe Nasso, Roberto Zamparelli
1Dipartimento di Medicina Cardiovascolare, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli Largo A, Gemelli, Roma. mgaudino@tiscalinet.it
Insights
Coronary artery bypass grafting with cardiopulmonary bypass significantly activates inflammatory and fibrinolytic markers. These markers generally normalize by hospital discharge, indicating a transient response to the procedure.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Hematology
Context:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Extracorporeal circulation (ECC) is frequently employed during CABG, potentially influencing systemic responses.
- Understanding the impact of ECC on inflammatory and hemostatic pathways is crucial for patient management.
Purpose:
- To investigate the temporal changes in key inflammatory and fibrinolytic markers following primary elective CABG with ECC.
- To compare the course of these markers under normothermic versus hypothermic perfusion conditions.
- To correlate marker profiles with clinical outcomes and complications.
Summary:
- This study prospectively monitored 113 patients undergoing primary isolated CABG with ECC.
- Inflammatory markers (CRP, IL-6, WBC) and fibrinolytic markers (PAI-1, fibrinogen, PT, aPTT, platelets) were assessed preoperatively and at multiple time points postoperatively.
- While most markers returned to baseline by discharge, C-reactive protein remained elevated, and platelet counts showed delayed normalization.
Impact:
- Cardiopulmonary bypass demonstrably activates the inflammatory response and disrupts the hemostatic/fibrinolytic balance.
- The findings provide insights into the dynamic physiological changes occurring after CABG with ECC.
- This knowledge can inform strategies for optimizing patient recovery and minimizing complications.
Background:
The aim of this study was to determine the course of the main inflammatory and fibrinolytic markers in patients undergoing primary elective coronary artery bypass graft with extracorporeal circulation.
Methods:
One hundred and thirteen patients (105 males, 8 females) undergoing primary isolated coronary artery bypass with normo- (37 degrees C) or hypothermic (26 degrees C) systemic perfusion were prospectively studied. The clinical course of the patients was recorded and inflammatory and fibrinolytic markers (C-reactive protein, fibrinogen, interleukin-6, plasminogen activator inhibitor-1, prothrombin time, activated partial thromboplastin time, platelets and white blood cell counts) were determined before surgery, 24, 48 and 72 hours thereafter, and at hospital discharge.
Results:
Two patients died (mortality 1.7%) and 6 had a major complication (event free survival > 94%). Interleukin-6, lymphocyte, neutrophil and monocyte levels increased after surgery but returned to normal at hospital discharge. C-reactive protein levels increased after 24 hours and remained high at hospital discharge. Plasminogen activator inhibitor-1, prothrombin time, and activated partial thromboplastin time increased from few hours postoperatively and returned to normal before discharge. Platelets decreased immediately after surgery and normalized only at hospital discharge. Fibrinogen decreased in the first 24 postoperative hours, raised later and remained elevated at hospital discharge.
Conclusions:
Cardiopulmonary bypass activates inflammatory response and hemostatic/fibrinolytic balance in patients undergoing primary isolated coronary artery bypass.