Effect of Pericardial Blood Processing on Postoperative Inflammation and the Complement Pathways

• Published in: The Annals of thoracic surgery Vol. 85; no. 2; pp. 530 - 535
• Main Authors: Marcheix, Bertrand, MD, MS, Carrier, Michel, MD, Martel, Catherine, MS, Cossette, Mariève, MD, Pellerin, Michel, MD, Bouchard, Denis, MD, Perrault, Louis P., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2008; Elsevier Science
• Subjects: Aged; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Flow Velocity; Blood Transfusion, Autologous - instrumentation; Cardiology. Vascular system; Cardiopulmonary Bypass - methods; Cardiothoracic Surgery; Complement Activation; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Stenosis - mortality; Coronary Stenosis - surgery; Female; Humans; Hypoxia-Ischemia, Brain - prevention & control; Inflammation - prevention & control; Male; Medical sciences; Middle Aged; Pericardium; Pneumology; Postoperative Complications - prevention & control; Probability; Prospective Studies; Sensitivity and Specificity; Surgery; Survival Analysis; Treatment Outcome; 25; Postoperative; Biological fluid; Anesthesia; Complement; Inflammation; Circulatory system; Cardiology; Blood; Pericardium
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.08.050

Background The objective of the present study was to determine the effect of processing of pericardial blood with a cell-saving device (CS) and vacuum-assisted cardiopulmonary bypass (VACPB) on reduction of postoperative inflammation. Methods One hundred patients who underwent on-pump coronary artery bypass grafting surgery were included in a prospective randomized study. Patients were randomly assigned into four groups of 25 patients, each in a two-by-two factorial design: group A had no CS and no VACPB, group B had VACPB alone, group C had CS alone, and group D had CS and VACPB. The complement factors C4a, C3a, and C5a, and the terminal complex sC5b-9, MBL (mannose-binding lectin), and Bb were measured in plasma preoperatively and at 30 and 240 minutes after termination of CPB. Results Mean age, CPB, and aortic cross-clamping times were similar in all groups. At 30 and 240 minutes after CPB, C3a, sC5b-9, and Bb were increased and C5a and MBL levels were decreased compared with preoperative levels in all groups. At 240 minutes, Bb levels were lower in patients with CS ( p = 0.0002). Conclusions The present study shows that contemporary CPB remains associated with a striking activation of all complement pathways and its terminal component. The use of CS decreases the activation of the complement alternative pathway.