Heparin Binding Protein in Adult Heart Surgery

Abstract

Background. Heparin binding protein (HBP) is released from neutrophilic secretory vesicles upon neutrophil adhesion on the endothelium. HBP mediates capillary hyperpermeability experimentally. In sepsis, HBP predicts organ dysfunction. Cardiopulmonary bypass induces both neutrophil activation and hyperpermeability. We hypothesized that in cardiopulmonary bypass, HBP is released in the reperfused coronary circulation concomitantly with neutrophil adhesion. Methods. In 30 patients undergoing aortic valve replacement, concomitant blood samples were drawn from the coronary sinus and arterial line before aortic crossclamping and 5 min after reperfusion to calculate transcoronary differences. Plasma HBP concentrations, neutrophil markers lactoferrin and myeloperoxidase, myocardial injury marker heart-type fatty acid binding protein (hFABP) and leukocyte differential counts were measured. Results. Arterial HBP was 4.1 (3.6-5.3) ng/ml preoperatively and 150.0 (108.2-188.6) ng/ml after aortic declamping. HBP increased 39-fold, lactoferrin 16-fold and myeloperoxidase 4-fold during cardiopulmonary bypass. Before cardiopulmonary bypass, there were marginal transcoronary differences in HBP [1.4 (-0.4-3.6) ng/ml, p=0.001] and hFABP [0.4 (-0.04-3.5) ng/ml, p=0.001] but not in the other parameters. During reperfusion, transcoronary HBP release [6.4 (1.8-13.7) ng/ml, p<0.001] was observed, concomitantly with transcoronary neutrophil sequestration [-0.14 (-0.28-0.01) x10^9/l, p=0.001] and transcoronary hFABP release [6.9 (3.0-25.8) ng/ml, p<0.001]. There were no transcoronary differences in lactoferrin or myeloperoxidase during reperfusion. Conclusions. CPB results in substantial increase in circulating HBP. HBP is also released from the reperfused coronary circulation, concomitantly with coronary neutrophil adhesion and myocardial injury. HBP may be one candidate for a humoral factor mediating capillary leak in cardiopulmonary bypass.

Heparin-binding protein measurement improves the prediction of myocardial injury-related cardiogenic shock

“…Extracorporeal membrane oxygenation (ECMO) would be initiatively implemented in the operating room if patients had refractory hypotension and met the following conditions [15]: ① long CPB time (CPB time of > 4 h); ② need for high-dose vasoactive drugs (vasoactive-inotropic score ≥ 40); ③ cardiac index of < 2.2 L/ m 2 /min and MAP of < 60 mmHg; ④ arterial lactate level of > 5 mmol/L; and ⑤ failure in weaning from CPB. A recent study reported that HBP was released from reperfused coronary circulation concomitantly with coronary neutrophil adhesion and myocardial injury [21]. This finding may suggest that compared with arterial HBP, the HBP drawn from CS may be a more sensitive method for the intraoperative assessment of myocardial injury.…”

“…Therefore, blood samples were directly taken from the CS by surgeons and simultaneously drawn from the arterial line of the CPB by perfusionists. Moreover, the blood samples for research were drawn at two time points: ① time point 1: immediately before aortic cross-clamping; and ② time point 2: 5 min after aortic declamping [21]. It should be emphasized that the CS samples were obtained after ligaturing cannulations of the superior and inferior vena cava.…”

“…Therefore, HBP may be associated with cardiogenic shock. Pesonen et al reported that HBP was released into reperfused coronary circulation at the time of coronary neutrophil adhesion and myocardial injury [21]. Ristagno et al reported that elevated plasma heparinbinding protein is associated with early death after resuscitation from cardiac arrest [12].…”

Dynamics of heparin binding protein in cardiothoracic surgery using cardiopulmonary bypass – exploring its potential as a marker for postoperative infections.

“…To our knowledge, two studies have described HBP levels in cardiac surgery. Pesonen et al showed a 39fold increase in HBP concentration during cardiac surgery with CPB and Pan et al demonstrated that elevated HBP levels after the release of cross-clamp predicted myocardial injury related cardiogenicshock after cardiac surgery (13,16). However, neither study did fully describe the intra-and postoperative dynamics of HBP or investigate whether the administration of heparin and protamine have any effect on HBP levels.…”

“…Pesonen et al recently showed that HBP is increased during cardiac surgery with CPB (13). However, the effects of heparin and protamine were not investigated, and neither were the postoperative dynamics of HBP.…”