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[Inflammatory response and haematological disorders in cardiac surgery: toward a more physiological cardiopulmonary
C Baufreton1, J-J Corbeau, F Pinaud
1Service de Chirurgie Cardiaque et Département d'Anesthésie-Réanimation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France. ChBaufreton@chu-angers.fr
Insights
Systemic inflammatory response after cardiac surgery is linked to hemostasis issues. Off-pump surgery aids in understanding inflammatory triggers, emphasizing surgical technique for better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Inflammation Biology
- Hemostasis and Thrombosis
Context:
- Systemic inflammatory response (SIR) significantly contributes to morbidity and mortality in cardiac surgery.
- Previously, cardiopulmonary bypass (CPB) was solely implicated, but recent research highlights other factors.
- Off-pump surgery offers a clearer view of SIR's multiple, material-independent sources.
Purpose:
- To differentiate between material-dependent and material-independent factors contributing to SIR in cardiac surgery.
- To elucidate the complex inflammatory pathways activated during cardiac procedures.
- To underscore the surgical approach's role in mitigating SIR.
Summary:
- Cardiac surgery-associated SIR involves complement, platelets, neutrophils, and monocytes.
- The tissue factor pathway in coagulation is crucial and requires surgical consideration.
- Extracorporeal perfusion quality impacts organ perfusion, especially in the splanchnic area, exacerbating SIR.
- Off-pump surgery and minimally extracorporeal circulation (MECC) advancements aid in understanding and controlling SIR.
Impact:
- Highlights the critical role of surgical technique in managing SIR, beyond technological advancements.
- Provides insights for developing strategies to reduce postoperative systemic inflammation and improve patient outcomes.
- Emphasizes a holistic approach to cardiac surgery, integrating surgical strategy with understanding of inflammatory and hemostatic pathways.
Abstract:
The systemic inflammatory response in cardiac surgery is closely related to the haemostasis disturbances. It is responsible of a significant morbidity and mortality that was previously suspected to be caused by cardiopulmonary bypass alone. However, it is time now to clearly identify the factors that are material-dependent from that material-independent. From this point of view, off-pump surgery allowed for better comprehension of the multiple sources of the inflammatory response. Numerous pathways are activated, involving complement, platelets, neutrophiles and monocytes. The tissue pathway of the coagulation system, through tissue factor, is of major importance and has to be surgically considered in order to reduce the whole body inflammatory response postoperatively. The quality of the extracorporeal perfusion through its consequences on organ perfusion, particularly in the splanchnic area, also participates to this pathophysiological process. Beyond the progress of technology provided by the industry, particularly the minimally extracorporeal circulation derived from off-pump surgery evolution, the surgical approach is of major importance in the control of the systemic inflammatory response and must not be ignored yet.
