Cardiac and Vascular Surgery Induced Immunological Changes: Influence of the Cardio-Pulmonary Bypass

Tárnok, A; Hambsch, Jörg; Bone, P.; Schneider, P.

doi:10.1097/00024382-199703001-00427

Cited by 2 publications

(6 citation statements)

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“…This hypothesis is supported by our recent finding that monocyte activity (e.g., class II major histocompatibility complex expression) is regulated downward immediately after the start of the surgical procedure. 1 Similar results were reported by Habermehl (Habermehl P, University of Mainz, Germany; unpublished observations). During CPB, the phenotype of T lymphocytes changes into "naive" (CD45RA expressing) T lymphocytes.…”

supporting

confidence: 84%

“…

…”

mentioning

confidence: 99%

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Cardiopulmonary bypass–induced increase of serum interleukin-10 levels in children

Tárnok¹,

Hambsch²,

Schneider³

1998

The Journal of Thoracic and Cardiovascular Surgery

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During pediatric cardiac operations with cardiopulmonary bypass (CPB), the serum levels of various inflammatory cytokines change dramatically. 1 Recent studies in children demonstrate that interleukin-10 (IL-10), a cytokine that acts in an immunosuppressive manner, is liberated during 2 or after 3 pediatric cardiac operations. The information provided by these authors, however, are conflicting with respect to the amplitude and the kinetics of secreted IL-10. 2, 3 Seghaye and colleagues 2 reported two peaks of IL-10 release, one during and a second after CPB, with maximums at the end of CPB and 1 day after the operation, respectively. Data from Sugita and associates 3 indicate earlier IL-10 release, with maximums during reperfusion and a few hours after the operation. Their data are similar to data reported for adults 4 with respect to the kinetics of IL-10 release. In contrast, Sugita and associates 3 reported initial and peak IL-10 values that were more than 10 times as high as in adults 4 and in infants until 10 months after birth. 2 We analyzed the kinetics of IL-10, interleukin-6 (IL-6) and tumor necrosis factor-␣ (TNF-␣) release in children undergoing cardiac operations to clarify the release pattern of IL-10 in children.

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confidence: 84%

“…

…”

mentioning

confidence: 99%

Cardiopulmonary bypass–induced increase of serum interleukin-10 levels in children

Tárnok¹,

Hambsch²,

Schneider³

1998

The Journal of Thoracic and Cardiovascular Surgery

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“…Increased inflammatory response due to elevated sequestration of inflammation mediators is believed to be the reason for the high incidence of bad outcome after CPB [5,6,27]. Our data do not support this hypothesis because we found similar amounts and time course of IL-6, IL-8, whereas histamine [36] and TNF-␣ serum levels [35] declined during surgery and were later not significantly increased, irrespective of the type of surgery.…”

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confidence: 61%

“…Recent studies in adults [20,24] and our own studies in children [36] show that CPB has an influence on the cellular immune system [24]. An explanation for these changes is the selective adhesion and/or destruction of specific lymphocyte subsets in the different components of the extracorporeal circuit (e.g., tubing, filters, and oxygenator).…”

Section: Discussionmentioning

confidence: 95%

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Complement Activation, Cytokines, and Adhesion Molecules in Children Undergoing Cardiac Surgery with or without Cardiopulmonary Bypass

et al. 1999

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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.

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Cardiac and Vascular Surgery Induced Immunological Changes: Influence of the Cardio-Pulmonary Bypass

Cited by 2 publications

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Cardiopulmonary bypass–induced increase of serum interleukin-10 levels in children

Cardiopulmonary bypass–induced increase of serum interleukin-10 levels in children

Complement Activation, Cytokines, and Adhesion Molecules in Children Undergoing Cardiac Surgery with or without Cardiopulmonary Bypass

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