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Complement activation during major operations with or without cardiopulmonary bypass
Insights
Extracorporeal circulation activates the terminal complement pathway during major surgeries, impacting granulocyte counts. Monitoring both initial and terminal complement activation is crucial for understanding surgical pathophysiology.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Complement System Biology
Background:
- Major surgeries involve complex physiological responses.
- The complement system plays a role in inflammation and immune response.
- Understanding complement activation during surgery is vital for patient outcomes.
Purpose of the Study:
- To investigate complement activation during different surgical procedures.
- To assess the impact of extracorporeal circulation on complement pathways.
- To correlate complement activation with granulocyte response.
Main Methods:
- Measured plasma concentrations of C3dg and terminal complement complex.
- Quantified granulocyte (polymorphonuclear neutrophils) counts.
- Compared complement activation across aorta-coronary bypass, abdominal aneurysmectomy, and thoracotomy groups.
Main Results:
- Terminal complement complex increased significantly with extracorporeal circulation, alongside a granulocyte drop.
- C3dg levels rose during both extracorporeal circulation and abdominal aneurysmectomy, suggesting broader C3 activation.
- Thoracotomy without synthetic material showed no complement activation but increased granulocytes.
Conclusions:
- Extracorporeal circulation specifically activates the terminal complement pathway.
- Major surgeries, beyond extracorporeal circulation, can influence C3 activation.
- Comprehensive complement assessment, including initial and terminal pathways, is recommended during major operations.
Abstract:
Plasma concentrations of the complement products C3dg and the terminal complement complex, as well as the number of granulocytes (polymorphonuclear neutrophils), were assessed in patients undergoing aorta-coronary bypass with extracorporeal circulation, abdominal aneurysmectomy with implantation of an aortic graft, or thoracotomy without the introduction of synthetic material into the circulation. The concentration of terminal complement complex increased significantly only in the group undergoing extracorporeal circulation, with a corresponding drop in the number of granulocytes. In contrast, the C3dg concentration increased during both extracorporeal circulation and abdominal aneurysmectomy, which indicates that other factors than extracorporeal circulation may affect C3 activation during major operations. In the thoracotomy group, where the most pronounced increase in granulocytes was found, no complement activation was recorded. It is concluded that extracorporeal circulation activates the terminal pathway of complement and that assays detecting activation of both the initial and the terminal parts should be included when the pathophysiology of complement is examined during major operations and extracorporeal circulation.