Systemic inflammation and cardiac surgery: an update.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with the development of a systemic inflammatory response that can often lead to dysfunction of major organs. The systemic inflammation can be assessed intra- and postoperatively by measuring concentrations of inflammatory mediators in plasma and tissues. These concentrations, however, do not always correlate with the degree of observed organ dysfunction. Various strategies have been used to reduce inflammatory phenomena in patients undergoing CPB. Cardiac surgery without CPB has been performed increasingly with satisfactory results over the past few years. Attenuation of systemic inflammation and improved outcome in high risk patients are potential benefits of this technique. The emergence and expanding performance of cardiac surgical procedures without the use of CPB has given us an excellent tool to investigate the relative importance of CPB as a cause of systemic inflammation. Aprotinin is a protease inhibitor which is used in cardiac surgical patients for its haemostatic effects. Aprotinin has anti-inflammatory properties, the nature of which have not been completely clarified. This article presents a summary of the published literature investigating inflammatory response and organ dysfunction in patients who have cardiac surgery without CPB. It also presents an overview of recent data on the anti-inflammatory action mechanisms of aprotinin.
Asimakopoulos
G
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Cardiothoracic Department, Imperial College  School of Medicine at Hammersmith Hospital, London, UK. geoasi@hotmail.com
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007611:Aprotinin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001923:Brain Chemistry; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation; D002448:Cell Adhesion / Q000187:drug effects; D002634:Chemotaxis, Leukocyte / Q000187:drug effects; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D016207:Cytokines / Q000097:blood; D004730:Endothelium, Vascular / Q000187:drug effects; D006490:Hemostatics / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007431:Intraoperative Complications / Q000097:blood / Q000209:etiology*; D007527:Isoenzymes / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D008213:Lymphocyte Activation / Q000187:drug effects; D009102:Multiple Organ Failure / Q000209:etiology; D009206:Myocardium / Q000378:metabolism; D009414:Nerve Growth Factors; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D019210:Troponin I / Q000097:blood
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016207:Cytokines; D006490:Hemostatics; D018836:Inflammation Mediators; D007527:Isoenzymes; D009414:Nerve Growth Factors; D011480:Protease Inhibitors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D019210:Troponin I; D007611:Aprotinin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form