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Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response
J van den Goor1, R Nieuwland, A van den Brink
1Department of Cardio-thoracic Surgery, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.m.vandengoor@amc.uva.nl
Insights
Inflammation during cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) surgery did not alter the acute phase response. The type of CPB circuit used did not significantly impact postoperative inflammation markers.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Immunology
Background:
- Coronary artery bypass grafting (CABG) often involves cardiopulmonary bypass (CPB), which can trigger inflammatory responses.
- Different CPB circuits, specifically oxygenators, vary in their materials and biocompatibility, potentially influencing patient inflammation.
Purpose of the Study:
- To investigate the relationship between perioperative inflammation and the postoperative acute phase response in CABG patients undergoing CPB.
- To compare the inflammatory effects of different CPB oxygenator coatings: non-coated (UMS), Carmeda-coated (BPS), and Trillium-coated (BAS).
Main Methods:
- A prospective study involving 71 CABG patients randomly assigned to UMS, BPS, or BAS oxygenator groups.
- Plasma levels of terminal complement complexes (TCC), elastase, secretory phospholipase A2 (sPLA2), and C-reactive protein (CRP) were measured at various time points before, during, and after CPB.
Main Results:
- TCC and elastase levels increased during CPB and decreased postoperatively. BPS and BAS groups showed significantly lower TCC levels compared to the UMS group at the end of CPB and during the early postoperative period.
- Elastase concentrations also differed significantly between groups at the end of CPB.
- Postoperative sPLA2 and CRP levels increased in all groups, with no significant differences observed between oxygenator types.
Conclusions:
- Reducing the inflammatory response during CPB through material modifications does not alter the subsequent postoperative acute phase response in CABG patients.
- The postoperative acute phase response in CABG appears to be primarily driven by surgical trauma, anesthesia, and organ perfusion rather than the specific characteristics of the CPB circuit.
Objective:
In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated- (UMS), Carmeda- (BPS) or Trillium-coated oxygenators (BAS).
Methods:
Prospectively, 71 CABG patients were randomly allocated to one of the oxygenator groups (UMS: n=25, BPS: n=25 and BAS: n=21). Terminal complement complexes (TCC) and elastase were determined in plasma samples collected before, during and after bypass. Secretory phospholipase A2 (sPLA2) and C-reactive protein (CRP) were determined before and after bypass.
Results:
Demographic, CPB and clinical outcome data were similar for the three groups. TCC and elastase increased during CPB, and decreased thereafter. Significant differences between the groups were present in the levels of TCC at the end of CPB (P=0.002) and at the first (P=0.012) and second (P<0.001) postoperative days, the BPS and BAS groups having reduced levels of TCC compared to the UMS group. Also elastase concentrations differed significantly between the groups at the end of CPB (P<0.001). The postoperative sPLA2 and CRP levels increased in all three groups on the first and second postoperative days, but no significant differences were present between the groups.
Conclusions:
Material-induced reduction of the inflammatory response during CPB does not affect the postoperative acute phase response. Thus, in CABG patients this response seems relatively unaffected by the composition and/or biocompatibility of the modern CPB circuit and rather to be evoked by surgical trauma, anesthetics and organ perfusion.
