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Complement activation by the artificial surface of cardiopulmonary bypass is a persistent clinical problem
Joel David Bierer1, Roger Stanzel2, Mark Henderson2
1Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada. Joel.Bierer@nshealth.ca.
Scientific Reports
|July 29, 2025
Summary
Artificial surfaces in cardiopulmonary bypass (CPB) activate the complement system, releasing inflammatory mediators. This study quanties complement activation during CPB prime preparation, highlighting potential risks in pediatric cardiac surgery.
Area of Science:
- Immunology
- Biomedical Engineering
- Cardiovascular Surgery
Background:
- Artificial extracorporeal surfaces, common in procedures like cardiopulmonary bypass (CPB), can activate the alternative complement pathway.
- In pediatric cardiac surgery, complement activation is linked to systemic inflammation, increased morbidity, and delayed recovery.
- CPB circuits for small children often use allogeneic blood products, leading to higher concentrations of anaphylatoxins (C3a, C5a) in the prime.
Purpose of the Study:
- To characterize complement activation during ex-vivo sanguineous prime preparations of CPB circuits coated with phosphorylcholine.
- To quantify the levels of complement activation products (C3a, C3b, C5a, and terminal complement complex) in this context.
Main Methods:
- Collection of sequential samples during 45 ex-vivo sanguineous prime preparations of CPB circuits.
- Quantification of complement activation products including C3a, C3b, C5a, and terminal complement complex.
- Analysis using multivariable generalized linear mixed-effects models to identify predictors of complement activation.
Main Results:
- Evidence of alternative and terminal complement pathway activation was observed, indicated by increased concentrations of C3a, C3b, C5a, and terminal complement complex.
- Circuit exposure time was identified as a predictor for C3a concentration.
- Significant alternative complement activation occurred despite the use of phosphorylcholine biocompatibility technology.
Conclusions:
- Ex-vivo CPB prime preparation with allogeneic blood products triggers substantial alternative complement activation.
- Exposure to these activated mediators during CPB may promote endothelial inflammation, potentially impacting end-organ function and post-operative outcomes.
- Further research is needed to develop strategies for inhibiting complement responses to artificial surfaces in clinical settings.
