Effect of pericardial blood processing on postoperative inflammation and the complement pathways.
BACKGROUND
The objective of the present study was to determine the effect of processing of pericardial blood with a cell-saving device (CS) and vacuum-assisted cardiopulmonary bypass (VACPB) on reduction of postoperative inflammation.


METHODS
One hundred patients who underwent on-pump coronary artery bypass grafting surgery were included in a prospective randomized study. Patients were randomly assigned into four groups of 25 patients, each in a two-by-two factorial design: group A had no CS and no VACPB, group B had VACPB alone, group C had CS alone, and group D had CS and VACPB. The complement factors C4a, C3a, and C5a, and the terminal complex sC5b-9, MBL (mannose-binding lectin), and Bb were measured in plasma preoperatively and at 30 and 240 minutes after termination of CPB.


RESULTS
Mean age, CPB, and aortic cross-clamping times were similar in all groups. At 30 and 240 minutes after CPB, C3a, sC5b-9, and Bb were increased and C5a and MBL levels were decreased compared with preoperative levels in all groups. At 240 minutes, Bb levels were lower in patients with CS (p = 0.0002).


CONCLUSIONS
The present study shows that contemporary CPB remains associated with a striking activation of all complement pathways and its terminal component. The use of CS decreases the activation of the complement alternative pathway.
Marcheix
Bertrand
B
Department of Cardiovascular Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
Carrier
Michel
M
Martel
Catherine
C
Cossette
Mariève
M
Pellerin
Michel
M
Bouchard
Denis
D
Perrault
Louis P
LP
D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D001804:Blood Transfusion, Autologous / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003167:Complement Activation; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control*; D007249:Inflammation / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome