Acute phase and opsonin response in cardiac surgery patients: influence of underlying cardiac disease

Abstract

Cardiopulmonary bypass (CPB) leads to an activation of plasma cascade systems, complement activation, and an acute phase response. To evaluate the influence of the underlying cardiac disease on the activation pattern of these systems, we compared inflammatory changes in coronary artery bypass grafting (CABG) patients with patients undergoing aortic valve replacement. We investigated changes of the acute phase proteins alpha 1-proteinase inhibitor and fibrinogen, the unspecific opsonin fibronectin, and the complement components C3c and C4 induced by extracorporeal circulation in 12 patients undergoing aortic valve replacement and in 12 patients undergoing CABG. Concentrations of C3c and C4 decreased in both groups after the onset of CPB and C4 concentration remained below post-induction levels up to 24 h after onset of CPB (p = 0.04). Fibronectin levels dropped immediately before the onset of CPB (p = 0.01), reaching the lowest values after 20 min of extracorporeal circulation. Fibrinogen and alpha 1-proteinase inhibitor levels after induction of anaesthesia were significantly higher in the CABG group and remained higher throughout the entire study period (p < 0.001). As an indicator of a postoperative acute phase response, concentrations of both proteins rose in the postoperative period above post-induction levels (p < 0.02).

Development of C-reactive Protein and Fibronectin Levels in Coronary Surgery Patients.

“…8) The fibronectin monitoring did not show any statistically significant decrease in its postoperative levels in any of the groups studied, which was also true for group A prior to adjustment for hemodilution: this finding is not consistent with some past or recent studies that described a postoperative fall to 190 -150 µg/mL. [9][10][11][12] Our finding can be ascribed to an advanced surgical technique and improved extracorporeal circulation (shorter duration, use of the capillary oxygenator instead of the bubble oxygenator, lower priming of the extracorporeal circulation). Based on the fact that no acute fibronectin depletion was detected in any of the groups studied (fibronectin levels over 300 µg/mL are considered slight depletion and those under 250 µg/mL severe depletion), we concluded that the fibronectin dependent physiological mechanisms, namely non-immunoglobulin and complement independent opsonization and reticulo-endothelial potential for phagocytosis, were not altered in the patients studied.…”

The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

“…They recommend a discrimination between patients undergoing valve replacement and CABG as useful, especially if changes in the acute phase response or hemostatic function are investigated. 18 Due to this fact, we only investigated patients undergoing myocardial revascularization.…”

Aktivierung von Granulozyten und Antiproteasen bei herzchirurgischen Eingriffen mit extrakorporaler Zirkulation

“…Eingriffe am offenen Herzen und an den groûen Gefäûen unter Anwendung der extrakorporalen Zirkulation (EKZ) beinhalten eine Exposition des Blutes gegenüber Fremdoberflächen und systemische Antikoagulation. Dies führt zu einer Aktivierung zahlreicher Protein-Kaskaden-Systeme, darunter Gerinnungs-, Fibrinolyse-, Komplement-und Kallikrein-Kinin-System [1].…”