Response of the Cellular Immune System to Cardiopulmonary Bypass in vivo

Abstract

Cardiopulmonary bypass (CPB) is known to induce an inflammatory response. Previous studies reported an impairment of the cellular immune response with activation of neutrophils and changes in lymphocyte subpopulations. The objective of the present study was to investigate the effect of CPB on leukocyte activation in vivo. In 27 patients undergoing coronary artery bypass grafting, the quantitative and the qualitative response of leukocyte populations to CPB was analysed pre-, intra-, and postoperatively using flow cytometry. A significant increase in leukocyte counts was detected during CPB, resulting in a marked leukocytosis postoperatively. The total number of lymphocytes peaked in the early phase of CPB, followed by a significant decrease, mainly due to a loss in B and cytotoxic T lymphocytes. In contrast, the lymphocytopenia observed 8 h after protamin administration was mainly caused by a drop in the population of helper T lymphocytes. Activation of distinct cell populations could be detected during and following CPB. The results indicate an influence of CPB on the cellular immune system, however an immuno-suppression was detectable only transiently.

Complement Activation, Cytokines, and Adhesion Molecules in Children Undergoing Cardiac Surgery with or without Cardiopulmonary Bypass

“…Recent studies in adults [20,24] and our own studies in children [36] show that CPB has an influence on the cellular immune system [24]. An explanation for these changes is the selective adhesion and/or destruction of specific lymphocyte subsets in the different components of the extracorporeal circuit (e.g., tubing, filters, and oxygenator).…”

Off-pump coronary artery bypass grafting does not reduce lymphocyte activation

“…In contrast, lymphopenia, observed 8 h after the inactivation of heparin, was predominantly related to a drop of helper T lymphocytes. The authors considered that cardiopulmonary bypass was the main cause of these phenomena [17].…”

Adaptive immunity is severely impaired by open-heart surgery

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Such studies used the proliferation response of T cells to lectin such as phytohemagglutinin (PHA) as a marker of T cell-mediated immunity. The proliferation response of T cells to lectin is not antigen-specific and reflects only the proliferation of both naive and memory T cells (Fig.…”

“…by cardiac surgery involving cardiopulmonary bypass (CPB) [1][2][3][4][5][6][7][8][9][10][11][12][13] Indicators of cell-mediated immunity were the number of T cells, [11][12][13] the rate of lymphocyte subsets, [3][4][5][6][7][8][11][12][13] and proliferation response to lectin. 1,2,4,6,7,10,11 Since none of these indicators is antigenspecific, they do not always reflect adaptive immunity to a particular pathogen.…”