Modulation of Systemic Inflammatory Response after Cardiac Surgery

Abstract

Cardiac surgery and cardiopulmonary bypass initiate a systemic inflammatory response largely determined by blood contact with foreign surfaces and the activation of complement. It is generally accepted that cardiopulmonary bypass initiates a whole-body inflammatory reaction. The magnitude of this inflammatory reaction varies, but the persistence of any degree of inflammation may be considered potentially harmful to the cardiac patient. The development of strategies to control the inflammatory response following cardiac surgery is currently the focus of considerable research efforts. Diverse techniques including maintenance of hemodynamic stability, minimization of exposure to cardiopulmonary bypass circuitry, and pharmacologic and immunomodulatory agents have been examined in clinical studies. This article briefly reviews the current concepts of the systemic inflammatory response following cardiac surgery, and the various therapeutic strategies being used to modulate this response.

Hidrocortisona reduz as concentrações séricas dos biomarcadores inflamatórios séricos em pacientes submetidos a endarterectomia de carótida

“…7 Additionally, the magnitude of the systemic and tissue inflammatory process, assessed by measurement of these specific biomarkers may reflect the risk of postoperative complications and progression of the contralateral carotid disease. 7 Raja et al 12 claim that the systemic inflammatory response after cardiovascular surgery is due to ischemia-reperfusion injury to target organs caused by clamping of arteries and restoration of perfusion after release of the hemostatic forceps. Additionally, persistence of an elevated degree of postoperative inflammation can potentially be prejudicial to patients subjected to cardiovascular surgical interventions.…”

“…Additionally, persistence of an elevated degree of postoperative inflammation can potentially be prejudicial to patients subjected to cardiovascular surgical interventions. 12 However, Rubens et al 13 and Liguori et al 14 have concluded that the systemic inflammatory response is variable and can be influenced by patient comorbidities; intraoperative non-pharmacological interventions; type of anesthesia; perioperative hemodynamic conditions; surgical aspects (surgical incision, duration of the procedure, duration of arterial clamping and need for blood transfusion); and postoperative recovery. In order to ensure that the same perioperative conditions prevailed, we standardized general anesthesia and classical endarterectomy.…”

“…With regard to neurological symptoms, 50% (11) were symptomatic and 50% (11) asymptomatic. Contralateral carotid stenosis percentages were as follows: 54.54% (12) of the patients had < 50% stenosis; 36.36% (8) had from 50% to 69% stenosis, and 9.1% (2) had stenosis ≥ 70%.…”

Key Points for Curbing Cardiopulmonary Bypass Inflammation

“…The Table 4 lists the vast majority of potential pharmacologically useful agents. Raja and Dreyfus (2005) superbly describe all these curbing alternatives, which is a recommended reader 6 . The current literature on worldwide cardiac surgery excellence supports the overestimation of pathological inflammation in human CPB surgery.…”

Ist das SIRS/Sepsis-Syndrom in der Herzchirurgie Folge der extrakorporalen Zirkulation und damit unvermeidlich?

“…Neben Endotoxin sind auch Ischämie sowie Komplementaktivierung Stimuli der Zytokinfreisetzung [19]. Während der EKZ kommt es insbesondere zu erhöhten Interleukin(IL)-6-und IL-8-Spiegeln.…”