Activation of the lectin pathway of complement by cardiopulmonary bypass contributes to the development of systemic inflammatory response syndrome after paediatric cardiac surgery

Abstract

SummaryThe systemic inflammatory response is a challenge in the management of paediatric patients undergoing cardiac surgery. Although multi-factorial, a contribution by the lectin pathway of complement activation has been postulated. We therefore investigated the changes in serum levels of mannose binding lectin (MBL) and activities of MBL-MBL-associated serine protease (MASP)-1 and MBL-MASP-2 complexes immediately before and during surgery, throughout the first postoperative day and at discharge from the hospital. These changes were analysed in relation to postoperative complications. Blood samples were obtained from 185 children with congenital heart disease undergoing surgical correction with the use of cardiopulmonary bypass: preoperatively (MBL-1), 15 min after initiation of cardiopulmonary bypass (CPB) (MBL-E), 30 min (MBL-2), 4 h (MBL-3), 12 h (MBL-4) and 24 h (MBL-5) post-CPB and at discharge from hospital (MBL-K). Alterations in serum MBL levels were calculated as a ratio of its serum level at subsequent time-points (MBL-2, -3, -4, -5) to the preoperative (MBL-1) value. Decreases in MBL and MBL-MASP complexes were observed in all samples, correlating with a decrease in C4 and increase in C4a, confirming activation of the lectin pathway. Changes in MBL levels between children with an uncomplicated postoperative course and those suffering from infection or low cardiac output syndrome did not differ significantly, but significant differences were observed between the SIRS and non-SIRS groups. Paediatric cardiac surgery with the use of cardiopulmonary bypass activates the complement system via the lectin pathway and the latter contributes to the development of the post-bypass systemic inflammatory response.

Interaction of Mannose-Binding Lectin With Lipopolysaccharide Outer Core Region and Its Biological Consequences

“…Furthermore, R-LPS was reported to exhibit higher potency in cell activation through the TLR-4/MD-2 receptor ( 65 ). Although MBL deficiency has been associated with susceptibility to infections (especially in children or immunocompromised subjects), its contribution to life-threatening events (like post-operative SIRS) has also been proven ( 66 ). Our results contribute to a better understanding of MBL–LPS interaction.…”

Isolated and Combined Valve Surgery in Elderly Patients: A Comparison of Mid-Term Results

“…CPB also induces a systemic inflammatory response and lung injury that contribute to the significant morbidity of open heart surgery. 9,10) It is reasonable to assume that prolonged CPB times due to complex procedures affect the outcomes of cardiac valve operations in the elderly.…”

Deposition of mannose‐binding lectin and ficolins and activation of the lectin pathway of complement on the surface of polyurethane tubing used for cardiopulmonary bypass

“…Protein binding depends on surface roughness, chemical features and area—the latter factor is of particular importance in children, due to the relatively large area of the CPB circuit in comparison with the child's body mass and surface area. The activation of CPs and APs on the artificial surface is well known, but our recent data implicate the lectin pathway in the systemic inflammatory response syndrome after pediatric cardiac surgery …”