title: Systemic inflammatory response syndrome is reduced by preoperative plasma-thrombo-leukocyte aphaeresis in a pig model of cardiopulmonary bypass.
abstract: OBJECTIVE
  The systemic inflammatory response syndrome (SIRS) after cardiac surgery with cardiopulmonary bypass (CPB) exacerbates organ dysfunction and increases postoperative mortality. The aim of this study was to reduce SIRS after CPB in a pig model by profoundly decreasing all blood defence factors (complement, coagulation and fibrinolytic and contact systems, leukocytes and thrombocytes) using pre‑operative aphaeresis.
  
  
  METHODS
  Thirty-three pigs underwent 3 h of hypothermic CPB with 2 h of cardioplegic arrest, followed by 4 days of observation. One half of the sample underwent prebypass plasma-thrombo-leukocyte aphaeresis with the adjuvant leukofiltration.
  
  
  RESULTS
  In the control group, there were classical signs of SIRS (tachycardia, tachypnea and leukocytosis) postoperatively. There was also myocardial ischaemia and the need for inotropic support in 90% of the control animals. Neutrophils showed an increase in superoxide anion production (P < 0.001), and surface neutral protease activity (P < 0.001) and blood endotoxin levels increased (P < 0.01) compared with preoperative levels. In contrast, in the aphaeretic group, there were no classical signs of SIRS; no myocardial ischaemia; minimum neutrophil production of the superoxide anion and protease activity were recorded (P < 0.001); and endotoxin levels were also decreased (P < 0.05) compared with the controls. In the control group, the haemodynamic problems associated with disconnecting from CPB correlated with the histologic findings in the myocardium (leukocyte endothelial adhesion and leukodiapedesis).
  
  
  CONCLUSIONS
  Pre‑operative plasma‑thrombo-leukocyte aphaeresis significantly reduces the major symptoms of SIRS and organ dysfunction after 3 h of CPB without adverse effects, such as bleeding and infection, during the postoperative course.
authors.affiliation: Centre of Cardiovascular and Transplant Surgery, Pekarska 53, 656 91 Brno, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Wagner
authors.affiliation: Centre of Cardiovascular and Transplant Surgery, Pekarska 53, 656 91 Brno, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Piler
authors.affiliation: Centre of Cardiovascular and Transplant Surgery, Pekarska 53, 656 91 Brno, Czech Republic.
authors.forename: Borivoj
authors.initials: B
authors.lastname: Uchytil
authors.affiliation: University of Veterinary Medicine, Palackeho 1/3, 612 42 Brno, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Halouzka
authors.affiliation: Charles University, I. Faculty of Medicine, Ke Karlovu 11, 128 08, Prague, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Kovaru
authors.affiliation: Masaryk University, Faculty of Medicine, Komenskeho 2, 602 00, Brno, Czech Republic.
authors.forename: Marie
authors.initials: M
authors.lastname: Bobkova
authors.affiliation: Centre of Cardiovascular and Transplant Surgery, Pekarska 53, 656 91 Brno, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Nemec
mesh_terms: D000818:Animals; D001781:Blood Component Removal / Q000379:methods*; D001792:Blood Platelets; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004195:Disease Models, Animal; D006324:Heart Arrest, Induced / Q000379:methods; D007036:Hypothermia, Induced / Q000379:methods; D007937:Leukapheresis / Q000379:methods; D007962:Leukocytes / Q000502:physiology; D017202:Myocardial Ischemia / Q000209:etiology; D010949:Plasma; D010956:Plasmapheresis / Q000379:methods; D057234:Preoperative Period; D013552:Swine; D013556:Swine, Miniature; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*
keywords: cardiopulmonary bypass; plasma‑thrombo-leukocyte aphaeresis; systemic inflammatory response syndrome