Changes in Plasma Fibronectin Levels After Cardiac and Pulmonary Surgery: Role of Cardiopulmonary Bypass

Abstract

The changes in immunoassayable plasma fibronectin were studied during seven days after cardiac surgery with cardiopulmonary bypass (group A, 19 patients) or lung surgery without bypass (group B, 11 patients). In group A the fibronectin showed a series of rapid changes during the 24 perioperative hours. Simultaneous assessment of other plasma proteins (albumin, fibrinogen and immunoglobulin G) suggested that these changes mainly reflected hemodilution and hemoconcentration processes following the cardiopulmonary bypass, being influenced by the necessarily large transfusions of plasma. The fibronectin level decreased after day 1, with maximum depletion (averaging -32% of preoperative value) on day 3. Despite subsequent progressive rise, full restoration had not been reached by day 7. Group B did not show the initial rapid changes, but progressive fall in fibronectin level to a nadir on day 2 (-20% of preoperative) was followed by gradual return to outset value on days 4-5. The study demonstrated 1) that cardiac or lung surgery induces transient fibronectin depletion on days 2 to 3 postoperatively, and 2) that in surgery with cardiopulmonary bypass the decrease is significantly greater and more prolonged. It is proposed that this supplementary decrease is due to the large amounts of particulates of various origin entering the blood during the bypass.

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.…”