Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response.
OBJECTIVE
In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated- (UMS), Carmeda- (BPS) or Trillium-coated oxygenators (BAS).


METHODS
Prospectively, 71 CABG patients were randomly allocated to one of the oxygenator groups (UMS: n=25, BPS: n=25 and BAS: n=21). Terminal complement complexes (TCC) and elastase were determined in plasma samples collected before, during and after bypass. Secretory phospholipase A2 (sPLA2) and C-reactive protein (CRP) were determined before and after bypass.


RESULTS
Demographic, CPB and clinical outcome data were similar for the three groups. TCC and elastase increased during CPB, and decreased thereafter. Significant differences between the groups were present in the levels of TCC at the end of CPB (P=0.002) and at the first (P=0.012) and second (P<0.001) postoperative days, the BPS and BAS groups having reduced levels of TCC compared to the UMS group. Also elastase concentrations differed significantly between the groups at the end of CPB (P<0.001). The postoperative sPLA2 and CRP levels increased in all three groups on the first and second postoperative days, but no significant differences were present between the groups.


CONCLUSIONS
Material-induced reduction of the inflammatory response during CPB does not affect the postoperative acute phase response. Thus, in CABG patients this response seems relatively unaffected by the composition and/or biocompatibility of the modern CPB circuit and rather to be evoked by surgical trauma, anesthetics and organ perfusion.
van den Goor
J
J
Department of Cardio-thoracic Surgery, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.m.vandengoor@amc.uva.nl
Nieuwland
R
R
van den Brink
A
A
van Oeveren
W
W
Rutten
P
P
Tijssen
J
J
Eijsman
L
L
D000210:Acute-Phase Reaction / Q000209:etiology* / Q000276:immunology; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003167:Complement Activation; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000097:blood; D010741:Phospholipases A / Q000097:blood; D054467:Phospholipases A2; D011184:Postoperative Period; D011446:Prospective Studies; D013499:Surface Properties; D031446:Trillium
D020099:Coated Materials, Biocompatible; D002097:C-Reactive Protein; D010741:Phospholipases A; D054467:Phospholipases A2; D010196:Pancreatic Elastase