Understanding the inflammatory response to cardiac surgery

McGuinness, Jonathan; Bouchier‐Hayes, David; Redmond, John M.

doi:10.1016/s1479-666x(08)80113-8

Cited by 70 publications

(62 citation statements)

References 75 publications

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“…In addition, many cardiac surgery patients may have impaired autoregulation of kidney blood flow due perioperative administration of medications. Also, systemic inflammation provoked by the cardiopulmonary bypass plays a preponderant role in the development of kidney injury by promoting proinflammatory events that amplify the operative trauma [16], and certainly microemboli during cardiopulmonary bypass is also an important factor.…”

Section: Discussionmentioning

confidence: 99%

Fatores de risco para lesão renal aguda após cirurgia cardíaca

Rodrigues¹,

Évora²,

Bassetto³

et al. 2009

Rev Bras Cir Cardiovasc

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Fatores de risco para lesão renal aguda após cirurgia cardíacaRisk factors for acute kidney injury after cardiac surgery Abstract Objective: The objective of the present investigation was to identify risk factors for acute kidney injury in patients with normal levels of serum creatinine who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery.Methods: Data from a cohort of 769 patients, after the exclusion criteria were applied, were analyzed using bivariate analyses and binary logistic regression modeling.Results: Three hundred eighty one patients experienced CABG, 339 valve surgery and 49 went through both simultaneously. Forty six percent of the patients were female and the mean age was 57±14 years (13 to 89 years). Seventy eight patients presented renal dysfunction postoperatively (10%), of these 23% needed hemodialysis (2.4% of all patients). The mortality for the whole cohort was 10%. The overall mortality for patients experiencing postoperative renal dysfunction was 40 % (versus 7%, P<0.001), 29% for those who did not need dialysis and 67% for those who needed dialysis (P=0.004). The risk factors that were independently associated with AKI were: age (P<0.000, OR: 1.056), congestive heart failure (P=0.

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Section: Discussionmentioning

confidence: 99%

Fatores de risco para lesão renal aguda após cirurgia cardíaca

Rodrigues¹,

Évora²,

Bassetto³

et al. 2009

Rev Bras Cir Cardiovasc

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“…This is also linked with nutritional status: between 50% and 90% of LC patients lack sufficient nutritional reserve and have a poor metabolic state, with inadequate inflammatory and immune responses to surgery [40,41] . portopulmonary hypertension, and hepatic hydrothorax are typical pulmonary complications.…”

Section: Immune Dysfunction and Nutritional Statusmentioning

confidence: 99%

Outcomes of abdominal surgery in patients with liver cirrhosis

López-Delgado

Ballús

Esteve

et al. 2016

WJG

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Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and s p e c i a l i z e d a p p r o a c h c a n i m p r o v e o u t c o m e s ; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.Key words: Liver cirrhosis; Outcomes; Coagulopathy; Nutritional status; Abdominal surgery; Adaptive levels of expertise of the surgeons, anesthetists, and intensive care unit (ICU) staff. Liver function is usually assessed by the Child-Turcott-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores [11] . Early studies found 30 d mortality rates after surgery were 10% in CTP-A, 30% in CTP-B, and 76%-82% in CTP-C, figures that have not significantly changed in more recent assessments [12,13] . Despite the poor results, advances in the medical management of LC and life expectancy have increased the eligibility of these patients for abdominal surgery [14] . To be able to give definitive recommendations and indications for non-hepatic abdominal surgery in the cirrhotic population, it is important to identify the patients most likely to benefit from it. There is also a need to assess contemporary surgical techniques and the various scoring systems currently in use.This review summarizes the outcomes of patients with LC undergoing non-hepatic abdominal surgery. Indexed articles in Medline of series of patients with LC who underwent non-hepatic abdominal surgery between 1950 and March 2014 were reviewed using the OVID interface. We aimed to select manuscripts addressing outcome based on the degree of LC assessed with MELD and/or CTP scores. Articles addressing the pathophysiology of cirrhotic patients and the clinical implications in non-hepatic abdominal surgery were selected based on their importance, their date of publication, and the citations of the manuscripts. As for articles describing the different types of surgery in LC patients, the most recent publications were selected in order to preser...

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“…These levels were determined on the basis of the ability to reduce cytochrome c (cyt c). in the reaction mixture, 3x10 5 leukocytes, 100 nmol of cyt c (type iii, sigma aldrich) and 0.5 mg of zymosan (serva) were opsonized by 7.5% autologic serum for a period of 30 min before the experiment. parallel samples were incubated either with or without 120 µg of super oxide dismutase -sod (serva) for a total volume of 0.7 ml of pBs.…”

Section: Leukocyte Determinationmentioning

confidence: 99%

“…a pathological interaction, strengthened by protein systems, occurs between the vascular endothelium and the activated leukocytes and thrombocytes, resulting in the loss of vascular integrity, the loss of intravascular volume, the transition of activated cells into the tissues and hypoxia due to microcirculation failure 3,4 . The pathophysiology of sirs allows the possibility of prevention and therapy: prevention includes refinement of surgical techniques and improved biocompatibility of extracorporeal systems or systemic preconditioning 5 . such methods have achieved reasonable success but for complex and longer surgical procedures, they have not been effective.…”

Section: Introductionmentioning

confidence: 99%

Systemic inflammatory response syndrome is reduced by preoperative plasma-thrombo-leukocyte aphaeresis in a pig model of cardiopulmonary bypass

et al. 2016

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Objectives. The systemic inflammatory response syndrome (SIRS) after cardiac surgery with cardiopulmonary bypass (CPB) exacerbates organ dysfunction and increases postoperative mortality. The aim of this study was to reduce SIRS after CPB in a pig model by profoundly decreasing all blood defence factors (complement, coagulation and fibrinolytic and contact systems, leukocytes and thrombocytes) using pre-operative aphaeresis. Methods. Thirty-three pigs underwent 3 h of hypothermic CPB with 2 h of cardioplegic arrest, followed by 4 days of observation. One half of the sample underwent prebypass plasma-thrombo-leukocyte aphaeresis with the adjuvant leukofiltration. Results. In the control group, there were classical signs of SIRS (tachycardia, tachypnea and leukocytosis) postoperatively. There was also myocardial ischaemia and the need for inotropic support in 90% of the control animals. Neutrophils showed an increase in superoxide anion production (P < 0.001), and surface neutral protease activity (P < 0.001) and blood endotoxin levels increased (P < 0.01) compared with preoperative levels. In contrast, in the aphaeretic group, there were no classical signs of SIRS; no myocardial ischaemia; minimum neutrophil production of the superoxide anion and protease activity were recorded (P < 0.001); and endotoxin levels were also decreased (P < 0.05) compared with the controls. In the control group, the haemodynamic problems associated with disconnecting from CPB correlated with the histologic findings in the myocardium (leukocyte endothelial adhesion and leukodiapedesis). Conclusions. Pre-operative plasma-thrombo-leukocyte aphaeresis significantly reduces the major symptoms of SIRS and organ dysfunction after 3 h of CPB without adverse effects, such as bleeding and infection, during the postoperative course.

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Understanding the inflammatory response to cardiac surgery

Cited by 70 publications

References 75 publications

Fatores de risco para lesão renal aguda após cirurgia cardíaca

Fatores de risco para lesão renal aguda após cirurgia cardíaca

Outcomes of abdominal surgery in patients with liver cirrhosis

Systemic inflammatory response syndrome is reduced by preoperative plasma-thrombo-leukocyte aphaeresis in a pig model of cardiopulmonary bypass

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