Changes of Leukocyte Subsets in Coronary Artery Bypass Surgery: Cardiopulmonary Bypass Versus ‘Off-pump’ techniques

Diegeler, Anno; Tárnok, A; Rauch, T.; Haberer, Dorothea; Falk, Volkmar; Battellini, Roberto; Autschbach, Rüdiger; Hambsch, Jörg; Schneider, P.; Mohr, F. W.

doi:10.1055/s-2007-1010247

Cited by 37 publications

(35 citation statements)

References 8 publications

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“…In agreement with earlier findings, the systemic inflammatory reactions to CPB resemble to sepsis with increased pro-and anti-inflammatory cytokine release and reduction of the activity of the cellular innate and adaptive immune system (1,(32)(33)(34). To reduce the proinflammatory reaction the majority of surgical corrections for congenital heart disease are performed under highdose GC administration (15).…”

Section: Discussionsupporting

confidence: 85%

“…Typically, after surgical trauma T-cell numbers drop dramatically as a result of increased migration into the periphery, particularly into the lymphatic organs (34). Unfortunately, no studies exist on effects of GCs on T-lymphocytes in vivo during CPB surgery.…”

Section: Discussionmentioning

confidence: 99%

“…During bypass the hematocrit level was kept at 22-30% and the flow-rate was maintained at 2.7-3.5 l m À2 BSA per min. Hypothermia (28)(29)(30)(31)(32)(33)(34)(35) C) was induced by cooling the priming solution in the extracorporeal circuit and circulating blood with heat exchanger. During the cooling period all patients received sodium nitroprussid (0.3-2.0 lg/kg/min) for vasodilatation.…”

Section: Anesthesia and Antibiotic Regimementioning

confidence: 99%

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Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone

Bocsi

Hänzka

Osmančík

et al. 2011

Cytometry Part B Clinical

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Background: With the intention to reduce overshooting immune response, glucocorticoids are frequently administered perioperatively in children undergoing open heart surgery. In a retrospective study we investigated extensively the modulation of the humoral and cellular immune response by methylprednisolone (MP).Methods: This study was carried out on blood samples from two groups of children who had undergone surgical correction of atrial or ventricular septal defects, either without (MP 2 , n 5 10), or with MP administration (MP 1 , n 5 23, dose median 11 (IQR 10-16) mg kg 21 body weight) before cardiopulmonary bypass (CPB, duration median 42 (IQR 36-65) min). EDTA blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end, 4, 24, and 48 h after surgery, at discharge and at out-patient follow-up (median 8.2 (IQR 3.3-12.2) months after surgery). Complex blood analysis including clinical chemistry and flow cytometry were performed to monitor humoral immune response, differential blood count, lymphocyte subsets, and the degree of activation of various leukocyte subpopulations.Results: The patients' postoperative courses and follow-up were uneventful. Release of IL-6 and IL8 was reduced and that of the anti-inflammatory cytokine IL-10 upregulated by MP. Significant increase of circulating neutrophils and monocytes as inflammatory reaction to surgery and CPB contact was detected in both groups. However, invasion of monocytes to the periphery was delayed with MP. CD41 and CD81 T-lymphocyte counts were lower with MP treatment. B-lymphocyte count increased significantly after surgery in MP 1 but remained constant in MP 2 group. Conclusions: MP treatment partially decreased the pro-inflammatory effect of CPB surgery and induced anti-inflammatory effect on the cellular and humoral level.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Anesthesia and Antibiotic Regimementioning

confidence: 99%

See 1 more Smart Citation

Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone

Bocsi

Hänzka

Osmančík

et al. 2011

Cytometry Part B Clinical

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“…Furthermore, the increase of C5a is accompanied by a decrease of monocytes, which was clearly demonstrated by our previously reported results. 11 This phenomenon is explained by an increased adhesion of monocytes to the endothelial surface influenced by C5a. 12 Burrows et al 13 showed an increased release of premature monocytes from the bone marrow as a secondary reaction to the acute-phase response.…”

Section: Discussionmentioning

confidence: 99%

Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

Diegeler¹,

Doll²,

Rauch³

et al. 2000

Circulation

Self Cite

162

117

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Background-The introduction of limited approaches to the heart and the avoidance of cardiopulmonary bypass (CPB) aim to reduce the invasiveness of CABG by decreasing the systemic release of inflammatory cytokines, such as tumor necrosis factor (TNF)-␣, interleukin (IL)-6, and IL-8, as well as the anti-inflammatory agent IL-10. This study compares the humoral immune response in patients undergoing CABG with standard, minimally invasive, and "off-pump" techniques. Methods and Results-Thirty patients were divided into 3 operative groups: full sternotomy approach plus CPB (group A); full sternotomy approach, off pump (group B); and limited left anterior thoracotomy, off pump (group C). Plasma levels of TNF-␣ receptors p55 and p75, IL 6, IL-8, and IL-10 were taken at baseline, during CPB, and at 4, 24, and 48 hours and 6 days after surgery. A significant increased release of activated complement factors C5a and C3d, IL-8, and IL-10 was observed in patients subjected to CPB (group A) during the initial period and for a short time after perfusion (PϽ0.05). TNF-␣ receptors p55 and p75 showed a prolonged elevation (up to 48 hours) in the CPB group compared with the 2 off-pump groups. IL-6 showed no different release among the 3 surgical groups throughout the entire period. There was no significant difference in any parameter measured in relation to the type of operative approach. Conclusions-There is an inflammatory, as well as an anti-inflammatory, response during CABG that is related to the general surgical trauma.

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“…It is claimed that an extensive and sometimes overwhelming systemic inflammatory response (SIRS) followed by profound immune depression leading to severe infectious complications are due to CPB (22). Based on results of some studies, it is suggested that the beating heart surgery is superior to "on pump" surgery (5,6). However, data which are gathered in this field are contradictory.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Cardiac Surgery on Peripheral Blood Lymphocyte Populations

Jankovicova¹,

Kudlová²,

Koláčková³

et al. 2008

Acta Med. (Hradec Kralove, Czech Repub.)

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Summary: Background: Cardiac surgery using cardiopulmonary bypass (CPB) is associated with some adverse postoperative complications caused by an altered immune response. An alternative approach to cardiac surgery, operating without the use of CPB (i.e. off-pump surgery), seems to display less adverse impacts on the immune response. Patients and Methods: Peripheral blood lymphocytes in 40 patients undergoing cardiac surgery either with CPB ("on-pump") or without CPB ("off-pump") were followed using flow cytometry. The samples of peripheral blood were taken at five intervals: preoperatively, after termination of the surgery, on the first, on the third and on the seventh postoperative day, respectively. Results: The most substantial changes appeared on the first postoperative day in both subgroups of patients. While the percentage of both total T cells and CD4 + T cells were decreased, the percentage of HLA-DR + activated lymphocytes was increased. These changes were more profound in the "on-pump" subgroup compared to the "off-pump" subgroup. Conclusion: Our results may suggest that the "off-pump" surgical approach reveals less adverse impact on adaptive immune responses.

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Changes of Leukocyte Subsets in Coronary Artery Bypass Surgery: Cardiopulmonary Bypass Versus ‘Off-pump’ techniques

Abstract: The results indicate a reaction of the leukocyte subsets to coronary bypass surgery which is more related to the surgical trauma in general than to CPB in particular.

Cited by 37 publications

References 8 publications

Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone

Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone

Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

The Effect of Cardiac Surgery on Peripheral Blood Lymphocyte Populations

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