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Systemic inflammation present in patients undergoing CABG without extracorporeal circulation
E Fransen1, J Maessen, M Dentener
1Department of Cardiopulmonary Surgery, University Hospital Maastricht, The Netherlands.
Insights
Coronary artery bypass grafting (CABG) surgery causes systemic inflammation, not cardiopulmonary bypass (CPB). Neutrophil activation occurs only with CPB, indicating the surgical procedure itself drives the acute phase response.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Anesthesiology
Background:
- The systemic inflammatory response after coronary artery bypass grafting (CABG) is often attributed to cardiopulmonary bypass (CPB).
- Understanding the specific contributors to inflammation is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate the extent to which cardiopulmonary bypass (CPB) contributes to the systemic inflammatory response in patients undergoing coronary artery bypass grafting (CABG).
- To differentiate the inflammatory effects of the surgical procedure from those of extracorporeal circulation.
Main Methods:
- Prospective study involving 16 patients undergoing elective CABG, divided into CPB and non-CPB groups.
- Measurement of bactericidal permeability increasing protein (BPI), interleukin-6, lipopolysaccharide binding protein, and C-reactive protein.
- Serial blood sampling throughout the surgical procedure and post-operatively.
Main Results:
- Bactericidal permeability increasing protein (BPI) release from neutrophils significantly increased in patients undergoing CPB, but not in the non-CPB group.
- The increase in acute phase reactants (interleukin-6, lipopolysaccharide binding protein, C-reactive protein) was comparable in both CPB and non-CPB groups.
Conclusions:
- The acute phase response in CABG patients is primarily driven by the surgical procedure itself, rather than the cardiopulmonary bypass (CPB) technique.
- Early neutrophil activation is specifically associated with the use of extracorporeal circulation (CPB).
Study Objectives:
This study was conducted to evaluate to what extent the cardiopulmonary bypass (CPB) procedure in patients undergoing coronary artery bypass grafting (CABG) contributes to the systemic inflammatory response. Therefore, we measured bactericidal permeability increasing protein (BPI) as an indicator of neutrophil activation, interleukin 6 as inducer of the acute phase response, and lipopolysaccharide binding protein and C-reactive protein as parameters of the acute phase response in patients undergoing CABG either with or without the use of CPB.
Design:
Prospective study.
Setting:
Cardiopulmonary surgery department in a university hospital.
Patients:
Sixteen patients undergoing elective CABG were included. Eight patients underwent surgery with CPB, and eight patients underwent surgery without CPB (non-CPB).
Interventions:
In the CPB group, blood samples were taken upon induction of anesthesia, at the start of aortic cross-clamping, at aortic unclamping, and 0.5, 4, 8, and 18 h thereafter. In the non-CPB group, blood samples were taken upon induction of anesthesia, and 0.5, 4, 8, and 18 h after completion of the bypass graft anastomoses.
Measurements And Results:
BPI release from neutrophil granules markedly increased during surgery in CPB patients but not in non-CPB patients. The increase in acute phase reactants, however, was the same in both patient groups.
Conclusions:
These data indicate that the acute phase response in CABG patients, which has historically been ascribed to the CPB procedure, is predominantly caused by the surgical procedure per se. Early neutrophil activation, however, is seen only when extracorporeal circulation is used.