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Relationship between granulocyte elastase and C3a under protamine dosing in on-pump cardiac surgery
Hiromichi Fujii1, Shigefumi Suehiro, Hiroshi Kumano
1Department of Cardiovascular Surgery, Osaka City University Medical School, 1-4-3 Asahi-machi, 910-0833 Abeno-ku, Osaka, Japan. fujiihiro@msic.osaka-cu.ac.jp
Summary
Protamine administration does not increase granulocyte elastase (GEL) levels during cardiac surgery. Complement activation, measured by C3a, increases after protamine, but does not directly impact GEL release.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Biochemistry
Background:
- On-pump cardiac surgery activates the complement cascade and granulocytes.
- Protamine is administered to reverse heparin anticoagulation after cardiopulmonary bypass.
- The relationship between complement activation and granulocyte elastase (GEL) release following protamine administration is not fully understood.
Purpose of the Study:
- To investigate the effect of protamine administration on granulocyte elastase (GEL) and C3a concentrations.
- To determine if complement activation directly regulates granulocytes after protamine administration in cardiac surgery.
Main Methods:
- A randomized study of 30 patients undergoing coronary artery bypass grafting.
- Patients were assigned to receive protamine 5 or 35 minutes after cardiopulmonary bypass termination.
- Granulocyte elastase (GEL) and C3a concentrations were measured at seven time points.
Main Results:
- GEL concentrations increased significantly before aortic declamping but not after protamine administration.
- C3a concentrations did not increase during cardiopulmonary bypass but significantly increased after protamine administration.
- These findings suggest a dissociation between complement activation and GEL release post-protamine.
Conclusions:
- Protamine administration does not lead to an increase in GEL levels.
- Complement activation, indicated by C3a, does not directly influence GEL release in this context.
- The study suggests that complement does not directly regulate granulocytes via GEL after protamine administration in cardiac surgery.