Systemic inflammation and cardiac surgery: an update

Abstract

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with the development of a systemic inflammatory response that can often lead to dysfunction of major organs. The systemic inflammation can be assessed intra- and postoperatively by measuring concentrations of inflammatory mediators in plasma and tissues. These concentrations, however, do not always correlate with the degree of observed organ dysfunction. Various strategies have been used to reduce inflammatory phenomena in patients undergoing CPB. Cardiac surgery without CPB has been performed increasingly with satisfactory results over the past few years. Attenuation of systemic inflammation and improved outcome in high risk patients are potential benefits of this technique. The emergence and expanding performance of cardiac surgical procedures without the use of CPB has given us an excellent tool to investigate the relative importance of CPB as a cause of systemic inflammation. Aprotinin is a protease inhibitor which is used in cardiac surgical patients for its haemostatic effects. Aprotinin has anti-inflammatory properties, the nature of which have not been completely clarified. This article presents a summary of the published literature investigating inflammatory response and organ dysfunction in patients who have cardiac surgery without CPB. It also presents an overview of recent data on the anti-inflammatory action mechanisms of aprotinin.

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

“…Indeed, there is experimental evidence to suggest that the inflammatory response after cardiopulmonary bypass may result in more frequent filter clotting and in shorter filter run times. [16] The aPTT values of these patients are comparable to both studies by Vargas Hein et al [13,17] Nevertheless, in this study, iloprost was able to increase filter runtime significantly.…”

Cistatina C e taxa de filtração glomerular em cirurgia cardíaca com circulação extracorpórea

“…Its technological development provided significant benefits with lower complication rates. However, ECC triggers an important systemic inflammatory reaction with interstitial fluid accumulation, leukocytosis and organic dysfunction [15]. The following substances are generated during ECC: hemoglobin in the plasma, elastase, endotelin, free radicals including superoxides, hydrogen peroxide and hydroxyl radicals.…”

Anestesi ved åpen hjertekirurgi hos voksne

“…De fant ingen endring i basal filtrasjon, men evnen til å kunne øke filtrasjonshastigheten etter proteinbelastning gikk tapt i en uke etter kirurgien (63). Mulige mekanismer for nyreskade indusert av hjerte-lunge-maskin er ikke godt kartlagt, men har vaert relatert til hypoperfusjon, aktivering av kaskadesystemer som komplement og koagulasjon samt immunrespons som følge av kontakt mellom blod og kunstige overflater i hjerte-lungemaskinkretsen (64,65).…”