Chest
Clinical Investigations: SurgeryInflammatory Response to Cardiopulmonary Bypass: Mechanisms Involved and Possible Therapeutic Strategies
Section snippets
Complement Activation
The complement system consists of some 20 plasma proteins and forms part of the body's defense mechanism. It is activated in a cascade sequence by the classic and the alternative pathways during CPB. The exposure of blood to extracorporeal circuits activates the alternative pathway, leading to the formation of C3a and C5a,4, 5 while reversal of heparin with protamine activates the classical pathway with an associated rise in C4a levels and further rise in C3a levels.6, 7, 8 Endotoxin release in
Pharmacologic Strategies
Steroid Pretreatment—Old Question, New Answers: Corticosteroids have been used during open heart surgery for >30 years.129 However, the mechanism of this intervention is still incompletely defined. Early studies focused on the hemodynamic effects of corticosteroids. A single IV bolus of a massive dose of corticosteroids has been suggested as a therapy for low output syndrome after CPB, due to the effects of vasodilatation with increased venous capacitance.130 In a large series of patients
The More We Learn, the More We Have to Learn
Much has been discovered regarding the inflammatory cascade and its initiation by CPB, but many of the complex interactions in this process remain elusive. The mechanisms of this extremely complicated network underly so many changes, including complement activation, endotoxin release, leukocyte activation, the expression of adhesion molecules, and the release of many endogenous substances including oxygen-free radicals, arachidonic acid metabolites, cytokines, PAF, NO, endothelins, and others.
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Chest
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This study was supported by Fondation pour la Chirurgie Cardiaque, Belgium.