Limiting inflammatory response to cardiopulmonary bypass: pharmaceutical strategies.
A significant inflammatory response and subsequent organ dysfunction is known to be associated with the use of CPB. Pharmaceutical interventions, such as corticosteroids, statins and ACE-Is can attenuate the post-CPB inflammatory and immune response, by so doing, either directly or indirectly, reduce incidence of postoperative complications. Apart from its effects on lipids, statins have been found to reduce postoperative oxidative stress that may partly contribute towards improved graft patency. In addition, certain ACE-inhibitors can promote a pro-fibrinolytic environment, whose role on maintaining graft patency and clinical outcomes warrant further investigation. There is increasing evidence to support the use of combined clopidogrel with aspirin following CABG to improve graft patency, although its impact on reducing postoperative adverse events remains unclear. Factors such as drug bioavailability and individual variability in drug responses and metabolism of these antiplatelet agents can significantly influence clinical outcomes.
Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Calvin S H
CS
Ng
Song
S
Wan
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D000806:Angiotensin-Converting Enzyme Inhibitors; D000893:Anti-Inflammatory Agents; D000933:Antifibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors