In High-Risk Patients, Combination of Antiinflammatory Procedures During Cardiopulmonary Bypass Can Reduce Incidences of Inflammation and Oxidative Stress

Abstract

Previous studies showed that cardiopulmonary bypass (CPB) was directly associated with a global activation of the inflammatory response, production of oxygen free radicals, and signs of myocardial injury. We therefore evaluated, in the weakest patients, the biological and clinical benefits of a therapeutic optimization of CPB through the combination of several antiinflammatory procedures. High-risk patients undergoing cardiac surgery under CPB were included in this prospective randomized study. Control patients (n = 14) underwent conventional CPB, and treated patients (n = 13) underwent a CPB with Baxter Duraflo II heparin-coated circuits, high doses of aprotinin, and pre-CPB hemofiltration. Usual clinical hemodynamic and biological criteria, inflammation, and oxidative stress markers were measured before, during, and to the second postoperative day. Free radicals were quantified using electronic spin resonance spectroscopy with a spin trap. Significantly lower concentrations of C-reactive protein, interleukin-6, creatine kinase-MB, I-troponin, lactic acid, and systemic free radicals were observed in the plasma of treated patients. These patients had a reduction of postoperative complications and of the length of stay in the intensive care unit. Therefore, pre-CPB therapeutic optimization can reduce the inflammatory response, lower the level of oxidative stress, and help to ameliorate clinical outcome in high-risk patients.

Hyperoxic Condition Promotes an Inflammatory Response During Cardiopulmonary Bypass in a Rat Model

“…Many studies have shown that the walls of the CPB circuit activate white cells, platelets, and the complement system. Activated leukocytes release cytotoxic agents and ROS associated with systemic inflammation and organ damage (13,14). The increase in cytokines, such as ILs and necrosis factor (4), aggravates the inflammatory response (5).…”

Growth Differentiation Factor-15 (GDF-15) Levels Are Associated with Cardiac and Renal Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

“…The cellular response is mediated by the main effectors of the inflammatory response, including neutrophils, which degranulate and release cytotoxic molecules such as elastase, myeloperoxidase (MPO) and free radicals[1]. Several therapeutic strategies have thus been developed to minimize this inflammation and lessen organ dysfunction[2]. In a previous study carried out in our laboratory, we measured systemic and coronary sinus free-radical release during and following removal of the cross-clamp[3].…”

Ghrelin reduces myocardial injury following global ischemia and reperfusion via suppression of myocardial inflammatory response

“…Despite the relatively small number of studies investigating the effects of reducing the inflammatory response to myocardial reperfusion injury, the majority of these studies has shown evidence of myocardial protection [9]. Ghrelin is an orexigenic hormone identified as an endogenous ligand for the growth hormone secretagogue receptor (GHSR) and discovery after of the growth hormone secretagogue type 1A receptor in 1996 [10] and was reported by Masayasu Kojima and colleagues in 1999 as peptide of 28 amino acids in rat and human stomachs [11].…”