Monocyte activation markers during cardiopulmonary bypass

Perfusion ◽  
2003 ◽  
Vol 18 (2) ◽  
pp. 83-86 ◽  
Author(s):  
R Fink ◽  
M Al-Obaidi ◽  
S Grewal ◽  
M Winter ◽  
J Pepper
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Renal Tissue ◽  
Monocyte Count ◽  
Activation Markers ◽  
Hla Dr ◽  
Atherosclerotic Process ◽  
Extracorporeal Support

Extracorporeal support during cardiac surgery initiates an inflammatory response, causing damage to cardiac, pulmonary and renal tissue [Post Pump Syndrome (PPS)]. This is accompanied by a neutrophil leucocytosis and lymphopenia, but less is known about the role of monocytes and markers of monocyte activity. We studied 19 patients undergoing cardiac surgery, obtaining blood samples from the aortic root (AR) and from the coronary sinus (< s) before the cardiopulmonary bypass (CPB), 1 min after release of the aortic crossclamp and 10 min after weaning from CPB (periods 1, 2 and 3). Leucocyte count, monocyte count and HLADR, CD15, CD11b and CD62L activation markers were measured. In samples obtained from the coronary sinus (CS), HLA-DR, expressed as a percentage of the monocyte count, decreased between periods 1, 2 and 3 by 78%, 66% and 43%, respectively. A similar change was observed in samples from the AR. Conversely, CD62L increased in the CS samples (55%, 68% and 73%), but revealed a lesser increase in the AR samples (51%, 68% and 63%). The other markers showed little change throughout the procedure. Reduced immunological competence could result from the decrease in HLA-DR counts. Increases in CD62L sensitizes monocytes to the tethering effects of endothelial integrins and might contribute to the atherosclerotic process.

Surgical setup for cardiopulmonary bypass through central cannulation

2021 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Surgical Care ◽  
Heart Lung Machine ◽  
American College Of Surgeons ◽  
History Of ◽  
Central Cannulation ◽  
First John ◽  
Clinical Advances

The introduction of cardiopulmonary bypass was one of the most important clinical advances of 1952. In that year, John Gibbon performed the first successful cardiac surgery using cardiopulmonary bypass. The procedure has been described as “One of the most impressive evidences of the role of investigative surgery in the history of medicine in the persevering efforts of Dr. Gibbon for more than 20 years, which finally culminated in a practical heart-lung machine”, at the first John H. Gibbon, Jr. Lecture at the annual meeting of the American College of Surgeons. Due to on-going advancements in cardiopulmonary bypass, many patients with complex heart disease requiring surgical care undergo cardiac surgery while the other organs remain adequately oxygenated and perfused. This tutorial discusses the access, surgical technique, and initiation of cardiopulmonary bypass through central cannulation and describes the safeguards and pitfalls.

MEASUREMENT OF CYTOKINE LEVELS BY CORONARY SINUS BLOOD SAMPLING DURING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

ASAIO Journal ◽  
1996 ◽  
Vol 42 (2) ◽  
pp. 59
Author(s):  
N. Karube ◽  
R. Adachi ◽  
Y. Ichikawa ◽  
T. Kosuge ◽  
Y. Yamazaki ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Blood Sampling ◽  
Cytokine Levels ◽  
Coronary Sinus Blood

scholarly journals 83 The predictive role of neutrophil-to-lymphocyte ratio in post-operative cardiopulmonary bypass surgery

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Valentina Bucciarelli ◽  
Francesco Bianco ◽  
Annaclara Blasi ◽  
Martina Primavera ◽  
Baldinelli Alessandra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pediatric Patients ◽  
Septal Defect ◽  
Left Ventricular ◽  
Conduction System ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Predictive Role

Abstract Aims Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality, and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes, and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery. To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB. Methods and results We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27 ± 10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 h from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed. Diagnoses of 146 patients included atrial septal defect (n = 36), ventricular septal defect (n = 20), pulmonary atresia/stenosis (n = 10), tetralogy of Fallot (n = 20), endocardial cushion defect (n = 8), left ventricular outflow tract obstruction (n = 14), anomalous origin of coronary artery (n = 6), complex CHD (n = 13), interrupted/hypoplastic aortic arch (n = 12), anomalous pulmonary venous return (n = 3). The mean CPB time was 121.6 ± 84.6 min. The median ICU hospitalization was 48 h [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P = 0.034 and P = 0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (log-rank, P = 0.029), especially when associated with POA (log-rank, P = 0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P = 0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P = 0.012, respectively], but not with JET. Conclusions 24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.

scholarly journals Effects of Perioperative Transcutaneous Electrical Acupoint Stimulation on Monocytic HLA-DR Expression in Patients undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass: Study Protocol for a Double-blind Randomized Controlled Trial

2019 ◽  
Author(s):  
Wen-ting Chen ◽  
Jin-feng Wei ◽  
Lan Wang ◽  
Deng-wen Zhang ◽  
Wei Tang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Infectious Complications ◽  
Bypass Grafting ◽  
Hla Dr ◽  
Acupoint Stimulation

Abstract Background: Cardiac surgery involving cardiopulmonary bypass (CPB) is known to be associated with a transient postoperative immunosuppression. When severe and persistent, this immune dysfunction predisposes patients to infectious complications, which contributes to a prolonged stay in the intensive care unit (ICU), even mortality. The effective prevention and treatment methods are still lacking. Recent studies revealed that acupuncture related techniques, such as electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), are able to produce effective cardioprotection and immunomodulation in adult and pediatric patients undergoing cardiac surgery with CPB, which leads to enhanced recovery. However, whether perioperative application of TEAS, a non-invasive technique, is able to improve immunosuppression of the patients with post cardiosurgical conditions is unknown. Thus, as a preliminary study, the main objective is to evaluate the effects of TEAS on the postoperative expression of monocytic human leukocyte antigen (-D related) (mHLA-DR), a standardized “global” biomarker of injury or sepsis-associated immunosuppression, in patients receiving on-pump Coronary Artery Bypass Grafting (CABG). Methods: This clinical study was a single-center clinical trial. The 88 patients scheduled to receive CABG under CPB will be randomized into 2 groups: the group of TEAS, and the group of transcutaneous acupoint pseudo - electric stimulation (Sham TEAS). Monocytic HLA-DR expression serves as a primary endpoint, and other laboratory parameters (e.g. IL-6, IL-10) and clinical outcomes (e.g. postoperative infectious complications, ICU stay time, and mortality) as the secondary endpoints. In addition, immune indicators, such as high mobility group protein 1 (HMGB1) and regulatory T cell (Treg) will also be measured. Discussion: The current study is a preliminary mono-centric clinical trial with a non-clinical primary endpoint, expression of mHLA-DR, aiming at determining whether perioperative application of TEAS has a potential to reverse CABG-associated immunosuppression. Although the immediate clinical impact of this study is limited, its results would inform further large sample clinical trial with using relevant patient-centered clinical outcomes as primary endpoints.

scholarly journals Innate immune deficiencies are associated with severity and poor prognosis in patients with COVID-19

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Marine Peyneau ◽  
Vanessa Granger ◽  
Paul-Henri Wicky ◽  
Dounia Khelifi-Touhami ◽  
Jean-François Timsit ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Innate Immune ◽  
Activation Markers ◽  
Extracellular Traps ◽  
Hla Dr ◽  
Immune Deficiencies ◽  
Severe Infections ◽  
Monocyte Subpopulations ◽  
Critical Patients

AbstractCOVID-19 can cause acute respiratory distress syndrome, leading to death in many individuals. Evidence of a deleterious role of the innate immune system is accumulating, but the precise mechanisms involved remain unclear. In this study, we investigated the links between circulating innate phagocytes and severity in COVID-19 patients. We performed in-depth phenotyping of neutrophil and monocyte subpopulations and measured soluble activation markers in plasma. Additionally, anti-microbial functions (phagocytosis, oxidative burst, and NETosis) were evaluated on fresh cells from patients. Neutrophils and monocytes had a strikingly disturbed phenotype, and elevated concentrations of activation markers (calprotectin, myeloperoxidase, and neutrophil extracellular traps) were measured in plasma. Critical patients had increased CD13low immature neutrophils, LOX-1 + and CCR5 + immunosuppressive neutrophils, and HLA-DRlow downregulated monocytes. Markers of immature and immunosuppressive neutrophils were strongly associated with severity. Moreover, neutrophils and monocytes of critical patients had impaired antimicrobial functions, which correlated with organ dysfunction, severe infections, and mortality. Together, our results strongly argue in favor of a pivotal role of innate immunity in COVID-19 severe infections and pleads for targeted therapeutic options.

scholarly journals The role of the department of surgical diseases №2 in the formation of cardiovascular surgery service in the Republic of Tatarstan (to the 80th anniversary of the department)

2015 ◽  
Vol 96 (6) ◽  
pp. 893-900
Author(s):  
R K Dzhordzhikiya
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiovascular Surgery ◽  
Heart Valve Disease ◽  
High Tech ◽  
City Hospital ◽  
Clinical Hospital ◽  
Diagnostic Center ◽  
The Republic

The main stages of development and formation of the cardiovascular surgery in the Republic of Tatarstan and the role of the department of surgical diseases №2, on the basis of which this branch of surgery engendered in the 60s of XX century, are represented. The first demonstrational cardiac surgeries (closed mitral commissurotomy) were performed in Kazan at the premises of the 3d city hospital by academician A.A. Vishnevsky in 1958. In 1963 the 6th city hospital became the main base of the department of surgical diseases №2 in Kazan, and the first cardiac surgery intervention was performed on April 15, 1963 on 26 years old patient with mitral stenosis of rheumatic etiology. In the 70s of XX century cardiac surgery service at the premises of 6th city clinical hospital got the status of Interregional cardiac surgery center. From the beginning of the 1990s, cardiopulmonary bypass surgery became leading in the department of cardiac surgery. In 1992 the cardiac surgery department of the 6th city clinical hospital was reorganized and became the Kazan Center of Cardiovascular Surgery with 75 beds, since 1995 bearing the name of professor N.P. Medvedev. In 2000 the department was headed by associate professor R.K. Dzhordzhikiya (doctoral thesis «Minimally invasive surgery of acquired heart valve disease», 2004). In 2005 more than 300 cardiopulmonary bypass surgeries has been performed in the clinic. In 2006 employees of the center in almost full strength moved to the Interregional clinical diagnostic center, the first cardiac surgery at the center was performed in September 2006. Annually the number of high-tech operations increases. At the same time scientific research work is carrying out. The generalizing research studing the results of the preservation of annulo-papillary continuity when replacing valve in the mitral position with mechanical prosthesis in patients with rheumatic disease conducted at the center was one of the first in Russia. The past 80 years of the history of the Department of Cardiovascular Surgery and the stable foundation laid by previous generations of researchers and clinicians, the glorious representatives of the Kazan school of cardiovascular surgery, serve as a guarantee of successive development of scientific and clinical work of the department and the whole cardiac surgery service in the Republic of Tatarstan.

scholarly journals Innate immune deficiencies in patients with COVID-19

2021 ◽  
Author(s):  
Marine Peyneau ◽  
Vanessa Granger ◽  
Paul-Henri Wicky ◽  
Dounia Khelifi-Touhami ◽  
Jean-François Timsit ◽  
...  
Keyword(s):  
Innate Immunity ◽  
Myeloid Cell ◽  
Innate Immune ◽  
Activation Markers ◽  
Icu Patients ◽  
Cell Functions ◽  
Hla Dr ◽  
Immune Deficiencies ◽  
Severe Infections

AbstractCOVID-19 can cause acute respiratory distress syndrome (ARDS), leading to death in a significant number of individuals. Evidence of a strong role of the innate immune system is accumulating, but the precise cells and mechanism involved remain unclear. In this study, we investigated the links between circulating innate phagocyte phenotype and functions and severity in COVID-19 patients. Eighty-four consecutive patients were included, 44 of which were in intensive care units (ICU). We performed an in-depth phenotyping of neutrophil and monocyte subpopulations and measured soluble activation markers in plasma. Additionally, myeloid cell functions (phagocytosis, oxidative burst, and NETosis) were evaluated on fresh cells from patients. Resulting parameters were linked to disease severity and prognosis. Both ICU and non-ICU patients had circulating neutrophils and monocytes with an activated phenotype, as well as elevated concentrations of soluble activation markers (calprotectin, myeloperoxidase, neutrophil extracellular traps, MMP9, sCD14) in their plasma. ICU patients were characterized by increased CD10low CD13low immature neutrophils, LOX-1+ and CCR5+ immunosuppressive neutrophils, and HLA-DRlow CD14low downregulated monocytes. Markers of immature and immunosuppressive neutrophils were strongly associated with severity and poor outcome. Moreover, neutrophils and monocytes of ICU patients had impaired antimicrobial functions, which correlated with organ dysfunction, severe infections, and mortality. Our study reveals a marked dysregulation of innate immunity in COVID-19 patients, which was correlated with severity and prognosis. Together, our results strongly argue in favor of a pivotal role of innate immunity in COVID-19 severe infections and pleads for targeted therapeutic options.One Sentence SummaryOur study reveals a marked dysregulation of innate immunity in COVID-19 patients, which correlates with severity and prognosis.

scholarly journals Effects of Perioperative Transcutaneous Electrical Acupoint Stimulation on Monocytic HLA-DR Expression in Patients undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass: Study Protocol for a Double-blind Randomized Controlled Trial

2019 ◽  
Author(s):  
Wen-ting Chen ◽  
Jin-feng Wei ◽  
Lan Wang ◽  
Deng-wen Zhang ◽  
Wei Tang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Infectious Complications ◽  
Invasive Technique ◽  
Effective Prevention ◽  
Hla Dr ◽  
Acupoint Stimulation

Abstract Abstract Background: Cardiac surgery involving cardiopulmonary bypass (CPB) is known to be associated with a transient postoperative immunosuppression. When severe and persistent, this immune dysfunction predisposes patients to infectious complications, which contributes to a prolonged stay in the intensive care unit (ICU), even mortality. The effective prevention and treatment methods are still lacking. Recent studies revealed that acupuncture related techniques, such as electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), are able to produce effective cardioprotection and immunomodulation in adult and pediatric patients undergoing cardiac surgery with CPB, which leads to enhanced recovery. However, whether perioperative application of TEAS, a non-invasive technique, is able to improve immunosuppression of the patients with post cardiosurgical conditions is unknown. Thus, as a preliminary study, the main objective is to evaluate the effects of TEAS on the postoperative expression of monocytic human leukocyte antigen (-D related) (mHLA-DR), a standardized “global” biomarker of injury or sepsis-associated immunosuppression, in patients receiving on-pump CABG. Methods: This clinical study was a single-center clinical trial. The 88 patients scheduled to receive CABG under CPB were randomized into 2 groups: the group of TEAS, and the group of transcutaneous acupoint pseudo - electric stimulation (Sham TEAS). Monocytic HLA-DR expression serves as a primary endpoint, and other laboratory parameters (e.g. IL-6, IL-10) and clinical outcomes (e.g. postoperative infectious complications, ICU stay time, and mortality) as the secondary endpoints. In addition, some immune indicators, such as high mobility group protein 1 (HMGB1) and regulatory T cell (Treg), possibly related to the mechanism of TEAS, will also be measured. Discussion: The current study is a preliminary mono-centric clinical trial with a non-clinical primary endpoint, expression of mHLA-DR, aiming at determining whether perioperative application of TEAS has a potential to reverse CABG-associated immunosuppression. Although the immediate clinical impact of this study is limited, its results would inform further large sample clinical trial with using relevant patient-centered clinical outcomes as primary endpoints. Trial registration: This study was approved by Ethics Committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine with the number 2016-455-06-01. The results of the trial will be published in an internationally peer-reviewed journal. This study was registered at ClinicalTrials with the Identifier NCT02933996 on 13 October 2016, https://www.clinicaltrials.gov/ct2/show/NCT02933996 Keywords: CABG; TEAS; immunosuppression; mHLA-DR

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