Immunological aspects of cardiopulmonary bypass

Knudsen, Flemming; Andersen, Lars Willy

doi:10.1016/0888-6296(90)90246-c

Cited by 68 publications

(22 citation statements)

References 79 publications

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“…With the introduction of radioimmunosassays (RIA) in the early 1970's, complement activation during cardiopulmonary bypass could be detected at low levels [7]. RIA-tests for C3a, C4a and C5a were made commercially available, and increased plasma levels of these so called anaphylatoxins could be detected in a multitude of clinical and experimental settings.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal dose of protamine for hemostasis has achieved great interest: an excessive dose of protamine after CPB can prolong ACT and decrease platelet function [7], but it has not been confirmed that this leads to increased postoperative bleeding [8,9]. Khan et al, [8] demonstrated a hypocoagulative thrombelastography pattern when excess protamine was added in-vitro to blood samples from heparinized patients undergoing cardiac surgery with CPB, but did not investigate whether this had any significance for actual postoperative bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgery

Schaub¹,

Thomas²,

Fridh³

et al. 2013

Cardio Vasc Syst

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Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgerySchaub, Christian; Thomas, Owain; Åkervall Fridh, L; Schött, Ulf Link to publication Citation for published version (APA): Schaub, C., Thomas, O., Åkervall Fridh, L., & Schött, U. (2013). Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgery. Cardivascular System, (1). DOI: 10.7243/2052-4358-1-1 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal AbstractBackground: An optimal dosage and infusion regime for protamine reversal of heparin after cardiopulmonary bypass is important. Methods: Protamine dosages of either 2mg/kg or 4mg/kg bodyweight were compared in 40 patients after first time coronary arterial bypass grafting. Protamine was infused with a syringe driver over 20 minutes. Arterial blood sampling was performed prior to and during surgery, before and at 0.3, 0.6, 1, 3, 6 and 25h after the protamine infusion. C3a-desArg and C4a-desArg were analysed by radioimmunoassay. Coagulation was assayed with Sonoclot and activated clotting time. Results: Significantly higher inter-group plasma levels of C3a-desArg were seen with the greater protamine dose from 0.3-0.6h, but none for C4a-desArg. Sonoclot parameters and leucocyte count differed significantly between the groups up to 6h, indicating hypercoagulabilty with the higher protamine dose. Significantly longer ACT in the low protamine dosage group indicited unblocked heparin with nonsignificant increased drainage bleeding and transfusions. There were no signs of allergic or anaphylactic reactions in any of the groups. Conclusion: Keeping the protamine dose low, minimizes complement activation with less viscoelastic signs of hypercoagulability. However there is an increased risk for drainage bleeding and unnecessary transfusion if heparin is not fully reversed with protamine post cardiopulmonary bypass. The present study was underpowered to detect significant differences in bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgery

Schaub¹,

Thomas²,

Fridh³

et al. 2013

Cardio Vasc Syst

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“…As a result, we were able to avoid the adverse effects of using CPB, which has been demonstrated to have an inhibitory effect on the various components of the immune system. [8][9][10] It has been shown for instance that the activity of natural killer cells is inhibited by CPB and remains so in the immediate postoperative period. Schoenmakers and colleagues, 11) however, found no evidence that off-pump surgery is superior to on-pump in patients undergoing concomitant cardiac and pulmonary surgery.…”

Section: Discussionmentioning

confidence: 99%

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Hosoba

Hanaoka

Suzuki

et al. 2012

ATCS

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Background: We report our experience of cardiac surgery with concomitant pulmonary resection, based on analysis of the results. Methods: Eleven patients (1 woman, 10 men) underwent cardiac surgery simultaneously with pulmonary resection; ten of them through median sternotomy. The cancer pathology consisted of non-small cell carcinoma (n = 10), and benign teratoma (n = 1). All lung lesions were removed using a wedge resection. Cardiac procedures consisted of off-pump coronary artery bypass grafting (n = 4), aortic valve replacement (n = 3), mitral valve plasty (n = 2), total arch replacement (n = 1), and descending aorta replacement (n = 1). Lung wedge resections were performed after induction with protamine sulfate. Results: The mean follow-up period was 19 ± 11 months (2-34). There was no operative mortality and no major cardiac complications. Three patients underwent a subsequent lobectomy through lateral thoracotomy. There were two postoperative deaths: one was from an unknown cause, 8 months postoperatively and another was from a lung cancer recurrence, 9 months after surgery. There were two local recurrences, 9 months and 14 months, postoperatively. The mean cancer-free period was 17 ± 10 (2-32) months. Conclusion: Rates of operative mortality and morbidity following cardiac surgery with concomitant pulmonary resection were favorable, and early to midterm results were acceptable. Keywords: lung cancer, concomitant cardiac surgery, wedge resection Ann Thorac Cardiovasc Surg 2012; 18: 8-11 doi: 10.5761/atcs.oa.11.01717 sequential and concomitant procedures, 1-4) the choice of which depends on the individual institution. Some institutions conduct a staged surgical procedure in which the cardiac surgery is mostly performed first followed by the lung surgery. Potential problems with this approach include delay in the lung resection due to the postoperative recovery phase and the additional cost of two operations. However, the concomitant procedure also has its shortcomings, such as the risk of dissemination due to manipulation of the pulmonary lobe, mechanical stress on the cardiac chambers, inability to perform radical lymph node dissection, and the risk of increasing the amount of blood loss due to the effect of heparinization.We studied a series of eleven patients who underwent concomitant pulmonary wedge resection and cardiac surgery. The aim of the study was to analyze the outcome of

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“…Segundo estudos, a anafilotoxina C5a parece ser a mais danosa durante a ativação maciça do complemento (16) . Pequenas quantidades de C5a podem induzir a agregação de neutrófilos e sua aderência ao endotélio vascular e às superfícies estranhas.…”

Section: Indução Das Interleucinas A) Interleucinas Pró-inflamatóriasunclassified

Síndrome da resposta inflamatória sistêmica na circulação extracorpórea: papel das interleucinas

Moura¹,

Pomerantzeff²,

Gomes³

2001

Rev Bras Cir Cardiovasc

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376Moura H V, Pomerantzeff P M A, Gomes W J -Síndrome da resposta inflamatória sistêmica na circulação extracorpórea: papel das interleucinas. Rev Bras Cir Cardiovasc 2001; 16(4): 376-87. OBJETIVOSEm seguida será apresentado o papel das principais interleucinas envolvidas dentro do quadro inflamatório subseqüente à circulação extracorpórea, RESUMO: A síndrome da resposta inflamatória sistêmica (SIRS) na cirurgia cardíaca ocorre, com maior freqüência, com o uso da CEC. Isto se deve ao contato do sangue com superfícies não endoteliais e, mais tarde, à reperfusão. Esse contato leva à liberação de componentes moleculares, dos quais as anafilotoxinas ativadas pelo fator de complemento, que estimulam a liberação de citocinas pró-inflamatórias, tais como a IL-1, IL-6, FNT-a. Estas interleucinas são responsáveis por indução de febre, neutrofilia, com aumento da adesividade entre neutrófilos e miócitos e/ou endotélio, e agem de forma sinergética estimulando a produção de outras interleucinas pelos monócitos e leucócitos (IL-6, IL-8). Observa-se que a isquemia intestinal, decorrente do uso da CEC, ocasiona a produção de IL-6, FNT-a, IL-1 no epitélio intestinal, e a reperfusão pós-CEC provoca a expressão de IL-1 e FNT-a no endotélio microvascular e pode gerar uma disfunção que danifica os cardiomiócitos. Seguindo a cascata de reações pós-CEC, a síndrome do distress respiratório do adulto é mediada pela IL-8, encontrada a nível alveolar. Cérebro e fígado também podem ser afetados pelos fenômenos causados pela isquemia/reperfusão e se demonstra que as interlucinas, uma vez mais (IL-8 e IL-13, respectivamente), têm um papel importante na série de eventos que ocorre. As técnicas de CEC bem como a anestesia podem influenciar a atividade das interleucinas. Não há um consenso sobre terapias preventivas ou de tratamento das complicações advindas da SIRS. Intervenção a nível dos mediadores da inflamação, procedimento de descontaminação digestiva, uso de drogas como a indometacina ou esteróides são opções possíveis. A regulação do processo inflamatório, de um modo geral, depende do equilíbrio entre citocinas pró-e anti-inflamatórias. Estas últimas são detectáveis no indivíduo normal, enquanto que as pró-inflamatórias apenas se manifestam localmente ou são quase inexistentes. Conclui-se que, o aumento da concentração das interleucinas pró-inflamatórias no organismo é um fato esperado, em grandes cirurgias, e que trará complicações se este aumento for exacerbado e se o organismo estiver muito debilitado. DESCRITORES: Circulação extracorpórea, efeitos adversos. Interleucinas. Procedimentos cirúrgicos cardíacos, efeitos adversos.RBCCV incluindo, ainda, os danos sistêmicos produzidos por estas interleucinas, bem como suas interações e como se manifestam, com base na visão de vários autores ao longo dos últimos anos.

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Immunological aspects of cardiopulmonary bypass

Cited by 68 publications

References 79 publications

Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgery

Protamine dosage effects on complement activation and sonoclot coagulation analysis after cardiac surgery

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Síndrome da resposta inflamatória sistêmica na circulação extracorpórea: papel das interleucinas

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