Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. An update

Kats, Suzanne; Schönberger, Jacques P.A.M.; Brands, Ruud; Seinen, Willem; Oeveren, Wim van

doi:10.1016/j.ejcts.2010.06.011

Cited by 47 publications

(43 citation statements)

References 65 publications

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“…16 Thus, vascular effects of ALP on clinical outcome may be offset by its protective effects in the attenuation of inflammatory reactions following OPCAB. 14 Using the Park et al data, 12 we evaluated the potential association between revascularization technique (OPCAB vs. PCI) and adverse outcome according to ALP level. After adjustments, the HR for mortality in OPCAB compared with PCI decreased as ALP increased (Figure S2).…”

Section: Outcomes Of Opcab Vs Pcimentioning

confidence: 99%

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Kim

Hong

Choi

et al. 2017

Circ J

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Background: Serum alkaline phosphatase (ALP) is related to vascular calcification. In a recent study on percutaneous coronary intervention (PCI) with a drug-eluting stent, higher ALP was associated with poor clinical outcomes in terms of mortality, myocardial infarction, and stent thrombosis. The aim of this study was to evaluate the relationship between preoperative ALP and clinical outcome of off-pump coronary artery bypass surgery (OPCAB). Methods and Results:We retrospectively enrolled and reviewed a total of 1,335 patients who underwent OPCAB. Patients were divided into tertiles based on preoperative serum ALP (<60, 60-76, and >76 IU/L). As preoperative ALP increased, the HR of mortality remained constant after adjusting for confounders. On Cox proportional hazards regression analysis, there was no association between ALP and all-cause mortality. The adjusted HR for all-cause mortality for the middle tertile was 0.882 (95% CI: 0.592-1.314, P=0.537), and 0.915 (95% CI: 0.605-1.383, P=0.672) for the highest tertile. In addition, no associations between ALP and cardiovascular mortality, myocardial infarction, revascularization, or major adverse cardiac events were found.Conclusions: Unlike after PCI, high ALP is not related to adverse clinical events, such as mortality, myocardial infarction, or revascularization after OPCAB. ALP might be considered when determining the optimal revascularization technique.

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Section: Outcomes Of Opcab Vs Pcimentioning

confidence: 99%

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Kim

Hong

Choi

et al. 2017

Circ J

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“…First, an immediate increase in endotoxin may derive from the priming fluid of the CPB circuit, the cardioplegic solutions, the extracorporeal devices, the infusion solutions, or the surgical materials. Alternatively, endotoxin may derive from spill-over into systemic circulation due to gut-related increased permeability [14]. This mechanism may occur at early as well as at later time points following CPB based on the severity of gut hypoperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the increase in circulating endotoxin following CPB has been linked to the duration of the bypass, and subsequently to greater risk of developing endotoxemia [14]. Increased endotoxin activity has been previously associated with renal dysfunction in the clinical framework of infection and sepsis [15,16,17], involving altered glomerular filtration, renal tubular damage and inflammation, and cellular apoptosis.…”

Section: Introductionmentioning

confidence: 99%

Association between Endotoxin Activity and Acute Kidney Injury in Cardiac Patients Undergoing Cardiopulmonary Bypass

Paternoster

Rubino

Balducci³

et al. 2014

Blood Purif

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Background/Aims: Cardiopulmonary bypass (CPB) has been thought to promote endotoxin translocation from the gut. Increased endotoxin activity (EA) has been related to a worsening of organ dysfunction, particularly acute kidney injury (AKI). This study aims to determine if CPB could influence EA after cardiac surgery, and if EA variations are associated with renal dysfunction following CPB. Methods: This was an observational study of patients subjected to complex cardiac surgery, likely to last for >120 min. Blood samples were obtained before, during and after CPB for EA analysis. AKI occurrence defined by the Acute Kidney Injury Network criteria was evaluated. Results: Eighteen patients were enrolled. EA significantly increased after 12 h following CPB. Variations of EA from baseline were significantly associated with variations of creatinine, i.e. AKI. Conclusion: Complex cardiac surgery requiring long CPB promotes EA increases that could be associated with variations of serum creatinine and AKI occurrence.

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“…2,3) Furthermore, CPB is closely related to elevated sera endotoxin during surgery. 4) The invasion of endotoxin is either from environmental endotoxin contamination or due to hyperperfusion-induced high permeability of gut barrier during CPB. Endotoxin, also called lipopolysaccharides (LPS), causes pro-inflammatory cytokines release in the blood of neonatal mice, such as TNF-α and IL-6, and the increase of circulating cytokine levels was correlated with impaired cardiac function.…”

Section: Liver X Receptor Activation Protects Against Inflammation Anmentioning

confidence: 99%

Liver X receptor activation protects against inflammation and enhances autophagy in myocardium of neonatal mouse challenged by lipopolysaccharides

Liu

Gao

et al. 2014

Bioscience, Biotechnology, and Biochemistry

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Liver X receptors (LXRs) has been emerged as negative regulators of cardiomyocytic inflammation. The cellular process of autophagy is believed to play a protective role in myocardium during the inflammatory status. In this study, we investigated the role of LXRs agonist TO901317 (TO) on lipopolysaccharides (LPS)-induced myocardial inflammation and autophagy. The results showed that TO pretreatment significantly reduced the LPS-induced infiltration of inflammatory cells, elevation of NF-κB protein, TNF-α, and IL-6 mRNA levels in the myocardium. Moreover, LPS stimulated autophagy in neonatal mice heart, and this effect was further enhanced by TO pretreatment as evidenced by increased LC3-II/ GAPDH ratio increment. Furthermore, TUNEL assay revealed LPS stimulation also increased the number of apoptotic cells in the myocardium, and the increment was inhibited by TO pretreatment. Our findings suggested that attenuation of inflammation and apoptosis, and enhancement of autophagy by TO may contribute to the protection of myocardium under inflammatory condition.

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Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. An update

Cited by 47 publications

References 65 publications

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery

Association between Endotoxin Activity and Acute Kidney Injury in Cardiac Patients Undergoing Cardiopulmonary Bypass

Liver X receptor activation protects against inflammation and enhances autophagy in myocardium of neonatal mouse challenged by lipopolysaccharides

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