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Eur J Cardiothorac Surg 2004;26:926-931
© 2004 Elsevier Science NL

Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response

^a Department of Cardio-thoracic Surgery, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
^b Department of Clinical Chemistry, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
^c HaemoScan, Groningen, The Netherlands
^d Department of Cardiology, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands

Received 1 April 2004; received in revised form 16 July 2004; accepted 23 July 2004.

^* Corresponding author. Tel.: +31-20-5662611 (hospital); +31-20-6848555 (home); fax: +31-20-6962289. (E-mail: j.m.vandengoor{at}amc.uva.nl).

Objective: In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated- (UMS), Carmeda^®- (BPS) or Trillium^®-coated oxygenators (BAS). Methods: Prospectively, 71 CABG patients were randomly allocated to one of the oxygenator groups (UMS: n=25, BPS: n=25 and BAS: n=21). Terminal complement complexes (TCC) and elastase were determined in plasma samples collected before, during and after bypass. Secretory phospholipase A₂ (sPLA₂) and C-reactive protein (CRP) were determined before and after bypass. Results: Demographic, CPB and clinical outcome data were similar for the three groups. TCC and elastase increased during CPB, and decreased thereafter. Significant differences between the groups were present in the levels of TCC at the end of CPB (P=0.002) and at the first (P=0.012) and second (P<0.001) postoperative days, the BPS and BAS groups having reduced levels of TCC compared to the UMS group. Also elastase concentrations differed significantly between the groups at the end of CPB (P<0.001). The postoperative sPLA₂ and CRP levels increased in all three groups on the first and second postoperative days, but no significant differences were present between the groups. Conclusions: Material-induced reduction of the inflammatory response during CPB does not affect the postoperative acute phase response. Thus, in CABG patients this response seems relatively unaffected by the composition and/or biocompatibility of the modern CPB circuit and rather to be evoked by surgical trauma, anesthetics and organ perfusion.

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