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Plasma fibronectin levels during cardiopulmonary bypass
W E Charash1, E D Foster, T M Saba
1Department of Physiology and Cell Biology, Albany Medical College of Union University, New York 12208.
Journal of Applied Physiology (Bethesda, Md. : 1985)
|November 1, 1990
Summary
Plasma fibronectin (cold-insoluble globulin) levels significantly decrease during cardiopulmonary bypass due to dilution and consumption. Levels remained low post-surgery, suggesting complex mechanisms beyond simple dilution.
Area of Science:
- Biochemistry
- Immunology
- Cardiovascular Surgery
Background:
- Plasma fibronectin, a glycoprotein with opsonic and adhesive functions, plays a role in immune response and vascular integrity.
- Deficiency in plasma fibronectin is linked to respiratory failure in critically ill patients.
- Fibronectin interacts with collagen, actin, and heparin, influencing clot formation and immune cell activity.
Purpose of the Study:
- To investigate the changes in plasma fibronectin levels during cardiopulmonary bypass.
- To determine if dilution alone accounts for the observed decrease in fibronectin concentration.
- To elucidate the mechanisms contributing to fibronectin level reduction in surgical patients.
Main Methods:
- Measurement of plasma fibronectin and albumin levels in nine adult patients undergoing elective cardiopulmonary bypass.
- Comparison of fibronectin and albumin concentrations before, during, and after cardiopulmonary bypass.
- Analysis of changes in relation to surgical trauma, heparinization, and bypass initiation.
Main Results:
- Plasma fibronectin decreased by 17% after chest opening and cannula placement.
- An additional 48% drop in fibronectin occurred during cardiopulmonary bypass, significantly more than the 25% decrease in albumin (corrected for pump prime).
- Fibronectin levels remained subnormal for up to 4 days post-operation, despite initial increases after bypass cessation.
Conclusions:
- The decline in plasma fibronectin during cardiopulmonary bypass is multifactorial, involving dilution, opsonic consumption, and potential complexation with heparin.
- Dilution alone does not explain the significant reduction in fibronectin levels.
- Postoperative fibronectin levels indicate a prolonged impact of the procedure on this crucial glycoprotein.