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Complement activation, cytokines, and adhesion molecules in children undergoing cardiac surgery with or without
A Tárnok1, J Hambsch, F Emmrich
1Paediatric Cardiology, Cardiac Centre Leipzig, University Hospital, Russenstrasse 19, D-04289 Leipzig, Germany.
Insights
Cardiopulmonary bypass (CPB) and cardiovascular surgery significantly alter blood parameters like complement and interleukins in children. While CPB may intensify some changes, these effects are not exclusive to CPB, suggesting broader surgical impacts.
Area of Science:
- Pediatric cardiovascular surgery
- Immunology
- Hematology
Background:
- Cardiopulmonary bypass (CPB) is used in major pediatric cardiovascular surgeries.
- The impact of CPB on blood parameters, including inflammatory markers and complement system components, requires detailed investigation.
Purpose of the Study:
- To investigate the effects of CPB on blood parameters in children undergoing major cardiovascular surgery.
- To compare changes in complement system components, interleukins, and adhesion molecules between children with and without CPB.
Main Methods:
- Prospective clinical study involving children undergoing cardiovascular surgery.
- Blood samples collected pre-operatively, intra-operatively, and post-operatively.
- Analysis of routine laboratory parameters, complement system components (C3, C4, C5, C1 inhibitor, C3d, C5a), interleukins (IL-6, IL-8), and soluble adhesion molecules (sICAM-1, sE-selectin).
Main Results:
- Serum concentrations of C3, C4, C5, and C1 inhibitor decreased during surgery and increased post-operatively in both CPB and control groups.
- Complement activation (increased C3d, C5a) occurred in both groups, with potentially more pronounced C3d increase in the CPB group.
- IL-6 levels increased significantly in both groups; IL-8 was detected post-surgery in controls.
- Soluble adhesion molecules sICAM-1 and sE-selectin decreased during surgery in both groups.
Conclusions:
- Cardiovascular surgery, with or without CPB, leads to significant changes in blood parameters, including inflammation mediators, complement consumption, and adhesion molecule levels.
- While CPB may exacerbate some inflammatory responses and complement activation, these changes are not exclusive to the CPB group.
- The observed alterations are likely a combined result of anesthesia, surgical trauma, and endothelial lesions, with potential additional CPB-specific effects contributing to postoperative morbidity.
Abstract:
The effect of cardiopulmonary bypass (CPB) on various blood parameters in children undergoing major cardiovascular surgery was investigated in a prospective clinical study. Blood samples of children with CPB (CPB group, n = 18) or without CPB (control, n = 12) were collected before, during, and after surgery. The concentration of routine laboratory parameters, components of the complement system (C3, C4, C5, C1 inhibitor, total hemolytic complement, C3d, and C5a), circulating interleukins (IL-6 and IL-8) and soluble adhesion molecules (sICAM-1 and sE-selectin) were determined. In both groups of patients the serum concentrations of C3, C4, C5, and C1 inhibitor were significantly affected by the treatments (p < 0.001), decreased immediately after onset of anesthesia, were minimal during surgery, and increased thereafter. No significant differences in the kinetics of these parameters were detectable between CPB and control group. In the CPB group the activation of the alternative pathway (increased C3d) was found to be a specific response (p = 0.005), but also in the control group C3d and C5a concentration increased significantly (p < 0.022), indicating complement activation. None of the effects that would be expected after activation of the complement system were specific for the CPB group. In both groups the serum levels of IL-6 increased dramatically during and/or after surgery (p = 0.001), and IL-8 was detectable after surgery in 10/12 control patients. The concentration of sICAM-1 and sE-selectin decreased during surgery (p < 0.04) and later did not increase above baseline. Our data suggest that increased serum levels of inflammation mediators and increased consumption of complement and adhesion molecules occur during cardiovascular surgery. Although complement activation and ICAM-1 consumption are more pronounced in the CPB patients, none of these changes occurs exclusively in the CPB group. We conclude, therefore, that these changes are the combined effect of anesthesia, surgical trauma, and endothelial lesions. Additional, undefined CPB-induced reactions may also contribute the postoperative morbidity.