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The factors effecting complement activation in open heart surgery
1Department of Thoracic and Cardiovascular Surgery, Anadolu University Medical Faculty, Eskişehir, Türkiye.
Insights
Complement system activation, measured by C3c and C4 levels, occurred during cardiopulmonary bypass and after protamine administration in rheumatic heart surgery patients. Anesthesia and heparin had minimal impact.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Complement System
Background:
- Rheumatic valve disease necessitates heart surgery, often involving cardiopulmonary bypass.
- The complement system is a key part of innate immunity that can be activated during surgical procedures.
Purpose of the Study:
- To investigate the activation of the complement system during heart surgery in patients with rheumatic valve disease.
- To determine the impact of cardiopulmonary bypass and protamine administration on complement components C3c and C4.
Main Methods:
- Blood samples were collected from 10 patients before anesthesia, post-anesthesia, after protamine, and post-incision.
- Complement components (C3c, C4), leukocyte, and neutrophil counts were measured.
- Pulmonary neutrophil trapping was assessed after cross-clamp release during cardiopulmonary bypass.
Main Results:
- Significant consumption of C3c and C4 was observed 30 minutes into cardiopulmonary bypass and 10 minutes after protamine administration.
- The effects of anesthesia and heparin on complement activation were not statistically significant.
- Pulmonary neutrophil trapping was also investigated.
Conclusions:
- Cardiopulmonary bypass and protamine administration are key triggers for complement system activation in rheumatic heart surgery.
- Understanding these triggers can inform strategies to mitigate complement-mediated inflammatory responses during cardiac surgery.
Abstract:
The activation of the complement system was investigated in 10 patients with rheumatic valve disease having heart surgery. The C3c, C4, leukocyte count and polymorphonuclear neutrophil count were determined in the blood samples taken before anaesthesia, after anaesthesia, 10 minutes after protamine administration and after the closure of the skin incision. In addition, atrial blood samples were taken after the release of the cross-clamp and pulmonary neutrophil trapping was investigated. In this study C3c and C4 consumption was found to take place after 30 minutes of CPB (cardiopulmonary bypass) and 10 minutes after protamine administration; the affects of anaesthesia and heparin were not significant.