Inflammatory response to cardiopulmonary bypass

Background Complement activation during cardiopulmonary bypass (CPB) surgery is considered to result from interaction of blood with the extracorporeal circuit. We investigated whether additional mechanisms may contribute to complement activation during and after CPB and, in particular, focused on a possible role of the acute-phase protein C–reactive protein (CRP). Methods and Results In 19 patients enrolled for myocardial revascularization, perioperative and postoperative levels of complement activation products, interleukin-6 (IL-6), CRP, and complement-CRP complexes, reflecting CRP-mediated complement activation in vivo, were measured and related to clinical symptoms. A biphasic activation of complement was observed. The ratio between the areas under the curve of perioperative and postoperative C3b/c and C4b/c were 3:2 and 1:46, respectively. IL-6 levels reached a maximum at 6 hours post-surgery. CRP levels peaked on the second postoperative day. Each complement-CRP complex had peak levels on the second...

Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia.

Systemic inflammatory response syndrome after cardiac operations

C ardiac surgery and cardiopulmonary bypass (CPB) activate a systemic inflammatory response characterized clinically by alterations in cardiovascular and pulmonary function. Significant morbidity is rare (approximately l%-2% of cases), but when severe acute lung injury occurs, mortality is high (50%-70%) (1). H owever, most patients undergoing CPB experience some degree of organ dysfunction as a result of activation of the inflammatory response. The purpose of this review is to examine the recent developments in our understanding of the pathophysiological mechanisms responsible for this response, the treatment modalities that have been used to ameliorate it, and the possible implications of these findings for the conduct of anesthesia for cardiac surgery.

F Maillet

Papers

Deleterious effects of cardiopulmonary bypass. A prospective study of bubble versus membrane oxygenation.