Tissue Injury and the Inflammatory Response to Pediatric Cardiac Surgery with Cardiopulmonary Bypass

Background There are few detailed descriptions of the inflammatory response to cardiac surgery with cardiopulmonary bypass (CPB) in children beyond 24 h postoperatively. This is especially true for the antiinflammatory cytokines and the extent of tissue injury. The aim of the current study was to describe the inflammatory and injury responses in uncomplicated pediatric cardiac surgery with CPB, where methylprednisolone and modified ultrafiltration (MUF) were used. Methods Blood samples were collected up to 48 h postoperatively. Cytokines (tumor necrosis factor-alpha and interleukin-6, -1beta, -10, and -1ra), complement (C3d and C4d) and coagulation system (prothrombin activation fragments 1 and 2 and antithrombin III) activation, neutrophil elastase, and the resulting tissue injury (creatine kinase, lactate dehydrogenase, alanine transaminase, amylase, and gamma-glutamyl transferase) were measured. Results The proinflammatory cytokine release varied widely, in contrast to a clear-cut antiinflammatory response. Cytokine concentrations did not decrease immediately after MUF, and no rebound increases later in the postoperative period were observed. The coagulation system, but not complement, was activated. There was a late release of C-reactive protein. Tissue injury could be quantified biochemically without evidence of hepatic or pancreatic dysfunction. Conclusion In this group of uncomplicated subjects, the antiinflammatory cytokine and tissue injury responses were well defined, in contrast to a variable proinflammatory cytokine release. This was accompanied by activation of the coagulation system but not of complement. Concentrations of inflammatory mediators did not decrease immediately after MUF, and there was no evidence for rebound release later in the postoperative period.

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Association Between Tumor Necrosis Factor α 308G/A Polymorphism and Increased Proinflammatory Cytokine Release After Cardiac Surgery With Cardiopulmonary Bypass in the Korean Population

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2009.03.004 ◽

2009 ◽

Vol 23 (5) ◽

pp. 646-650 ◽

Cited By ~ 13

Author(s):

Seung Zhoo Yoon ◽

In-Jin Jang ◽

Yoon Ji Choi ◽

Mae Hwa Kang ◽

Hye Ja Lim ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Tumor Necrosis Factor ◽

Proinflammatory Cytokine ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Α ◽

Korean Population ◽

Cytokine Release ◽

Factor Α ◽

Necrosis Factor

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The compromised inflammatory response to bacterial components after pediatric cardiac surgery is associated with cardiopulmonary bypass–suppressed Toll-like receptor signal transduction pathways

Journal of Critical Care ◽

10.1016/j.jcrc.2013.10.008 ◽

2014 ◽

Vol 29 (2) ◽

pp. 312.e7-312.e13 ◽

Cited By ~ 10

Author(s):

Yi-ping Li ◽

Jie Huang ◽

Shun-gen Huang ◽

Yong-gen Xu ◽

Yun-yun Xu ◽

...

Keyword(s):

Signal Transduction ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Pediatric Cardiac Surgery ◽

Signal Transduction Pathways ◽

Toll Like Receptor ◽

Receptor Signal

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Inflammatory Response and Endothelial Dysfunction Following Cardiopulmonary Bypass: Pathophysiology and Pharmacological Targets

Recent Patents on Inflammation & Allergy Drug Discovery ◽

10.2174/1872213x13666190724112644 ◽

2019 ◽

Vol 13 (2) ◽

pp. 158-173 ◽

Cited By ~ 3

Author(s):

Omar Giacinto ◽

Umberto Satriano ◽

Antonio Nenna ◽

Cristiano Spadaccio ◽

Mario Lusini ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Endothelial Dysfunction ◽

Inflammatory Response ◽

Extracorporeal Circulation ◽

Tissue Injury ◽

Vascular Endothelial Cell ◽

Endothelial Injury ◽

Mesh Terms ◽

Key Terms

Background: Endothelial injury occurring during cardiopulmonary bypass is a major contributing factor in the development of organ dysfunction, which leads to many of the postoperative complications occurring during cardiac surgery. Objective: This narrative review aims to summarize the main mechanisms of cardiopulmonary bypass - related disease, evaluating the unfavorable events leading to tissue injury, with a description of current pharmacologic and non-pharmacologic mechanisms to reduce CPB-related injury. Methods: A Medline/Pubmed/Scopus search was conducted using clinical queries with the key terms "cardiac surgery", “cardiopulmonary bypass”, "inflammation" and “endothelial injury”, and related MeSH terms, until July 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the same key terms from https://patents.google.com/, www.uspto.gov, and www.freepatentsonline.com. Results: In this review, we discuss the current knowledge of the mechanisms of vascular endothelial cell injury, the acute inflammatory response, and the regulatory factors that control the extent of vascular injury during extracorporeal circulation, summarizing the main target of anti-inflammatory pharmacologic and non-pharmacologic strategies. Conclusion: Inflammatory response and endothelial dysfunction following cardiopulmonary bypass are the prices to pay for the benefits offered during cardiac surgery procedures. Counteracting the detrimental effect of extracorporeal circulation appears to be crucial to improve clinical outcomes in pediatric and adult cardiac surgery. The intrinsic complexity and the tight interplay of the factors involved might require a holistic approach against inflammation and endothelial response.

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Etiological factors and clinical value of metabolic acidosis after cardiac surgery with cardiopulmonary bypass

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2019-18-3-35-43 ◽

2019 ◽

Vol 18 (3) ◽

pp. 35-43

Author(s):

A. O. Marichev ◽

S. V. Datsenko ◽

O. V. Deinega ◽

E. A. Kabakova ◽

E. S. Kurskova ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Metabolic Acidosis ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Postoperative Period ◽

Acid Base ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Lactate Acidosis

Aim – determine a forms of metabolic acidosis (MetAc) after cardiac surgery with cardiopulmonary bypass (CPB). Estimate signiﬁcance of MetAc in an early postoperative period.Material and methods. We included the 129 adult cardiac surgery patients. We studied the indicators of acid-base blood status, markers of systemic inﬂammation, an oxygen delivery and consumption, the hemodynamic parameters, the clinical course of the postoperative period.Results. The acid-base disorders were found in 73.6 % of cases. The metabolic acidosis was in 51.2 % of cases: the lactate acidosis was in 92.4 % and the hyperchloremic acidosis was in 7.6 %. The metabolic lactate acidosis was represented by two forms: 1. the acid-base disorders due to a low cardiac output syndrome with a decrease in oxygen delivery and contractility (14.7 %); 2. the lactate acidosis due to a systemic inﬂammatory response syndrome (49.2 % of cases). It is associated with a high delivery and a low oxygen extraction, increased cardiac output and a vasoplegia. Patients with these disorders had a higher level of leukocytosis after 24 hours of the end the operation, had a longer duration of respiratory support and a long ICU stay and hospital stay.Conclusion. The lactate acidosis is represented by two forms: the lactate acidosis associated with the low cardiac output syndrome and lactate acidosis associated with the systemic inﬂammatory response. The lactate acidosis is a predictor of adverse outcome after cardiac surgery with CPB and associated with a postoperative complications and a mortality.

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Inflammatory response of neutrophil granulocytes and monocytes after cardiopulmonary bypass in pediatric cardiac surgery

Intensive Care Medicine ◽

10.1007/s00134-002-1525-x ◽

2002 ◽

Vol 28 (12) ◽

pp. 1786-1791 ◽

Cited By ~ 15

Author(s):

Peter Gessler ◽

Juerg Pfenninger ◽

Jean-Pierre Pfammatter ◽

Thierry Carrel ◽

Clemens Dahinden

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Pediatric Cardiac Surgery ◽

Neutrophil Granulocytes

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Subzero balance: simple modified ultrafiltration (SBUF-SMUF) technique for pediatric cardiopulmonary bypass

Perfusion ◽

10.1177/02676591211027788 ◽

2021 ◽

pp. 026765912110277

Author(s):

Joel Bierer ◽

Mark Henderson ◽

Roger Stanzel ◽

Suvro Sett ◽

David Horne

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Systemic Inflammatory Response ◽

Pediatric Cardiac Surgery ◽

Infants And Children ◽

The Novel ◽

Continuous Form ◽

Harmful Effects

The use of cardiopulmonary bypass (CPB) can be associated with significant hemodilution, coagulopathy and a systemic inflammatory response for infants and children undergoing cardiac surgery. Intra-operative ultrafiltration has been used for decades to ameliorate these harmful effects. The novel combination of a continuous and non-continuous form of ultrafiltration, Subzero Balance Simple Modified Ultrafiltration (SBUF-SMUF) here described, seeks to enhance recovery from pediatric cardiac surgery and CPB.

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Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-020-04809-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Thiago Augusto Azevedo Maranhão Cardoso ◽

Gudrun Kunst ◽

Caetano Nigro Neto ◽

José de Ribamar Costa Júnior ◽

Carlos Gustavo Santos Silva ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Controlled Trial ◽

Artery Bypass ◽

Bypass Graft ◽

Volatile Anesthetic ◽

Serum Levels ◽

Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

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