Complement activation during major surgery: the effect of extracorporeal circuits and high-dose aprotinin.
OBJECTIVE
To assess the in vivo contribution to complement activation of an extracorporeal circuit and the use of high-dose aprotinin during major surgery.


METHODS
Sequential samples were obtained from 8 patients undergoing thoracic surgery, 20 patients undergoing orthotopic liver transplantation (OLT) using venovenous bypass, and 19 patients undergoing cardiac surgery using cardiopulmonary bypass (CPB).


METHODS
The latter two groups were part of a randomized controlled trial of high-dose aprotinin.


METHODS
Total complement activation was measured with the hemolytic complement activity and the C3 activation-specific marker, C3d antigen.


RESULTS
Complement activation did not occur during thoracic surgery. During OLT, C3d antigen levels, expressed as mean +/- standard deviation (SD), were elevated from baseline at skin closure (8.6 +/- 2.5 v 13.0 +/- 5.2 mg/L; p = 0.0082). During cardiac surgery, C3d antigen levels increased 10 minutes after the start of CPB (pre-CPB, 8.0 +/- 1.9 v 14.2 +/- 3.1 mg/L; p = 0.0001) and remained at greater than baseline values postoperatively (8.0 +/- 1.9 v 11.8 +/- 2.3 mg/L; p = 0.002). There was no difference in complement activation in those receiving high-dose aprotinin during OLT or cardiac surgery. Complement activation during cardiac surgery using extracorporeal circulation occurred to a greater extent than during OLT and thoracic surgery. Complement activation during cardiac surgery or OLT was not attenuated by the use of high-dose aprotinin.
Segal
H
H
Department of Cardiothoracic Surgery, National Heart and Lung Institute, Heart Science Centre, Harefield Hospital, Middlesex.
Sheikh
S
S
Kallis
P
P
Cottam
S
S
Beard
C
C
Potter
D
D
Townsend
E
E
Bidstrup
B P
BP
Yacoub
M
M
Hunt
B J
BJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D003167:Complement Activation; D005112:Extracorporeal Circulation; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D019616:Thoracic Surgical Procedures
D006490:Hemostatics; D007611:Aprotinin