[en] BACKGROUND: Cardiopulmonary bypass (CPB) initiates a whole-body inflammatory response where complement and neutrophil activation and cytokine release play an important role. This prospective trial examined the effects of both heparin-coated circuits and aprotinin on the inflammatory processes during CPB, with respect to cytokine release and neutrophil activation. METHODS: Two hundred patients undergoing cardiac surgery were randomized in four groups of 50 patients each: heparin-coated circuit with aprotinin (HCO-A) or without aprotinin (HCO) administration, and uncoated circuit with aprotinin (C-A) or without aprotinin administration (C). In groups receiving aprotinin, a high-dose regimen was given. In all groups, high initial doses of heparin were used (3 mg/kg intravenously). Tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8, and myeloperoxidase and elastase levels were measured in plasma samples taken before, during, and after CPB. RESULTS: In all groups, the TNF-alpha, IL-6, and IL-8 levels reached a maximum after protamine administration. After 24 hours, they remained significantly elevated (IL-6 and IL-8) or returned to baseline values (TNF-alpha). A similar pattern was observed with myeloperoxidase and elastase levels. No significant intergroup differences were observed. CONCLUSIONS: CPB is associated with cytokine release and neutrophil activation, which are not attenuated by the use of heparin-coated circuits or by the administration of aprotinin. Aprotinin and heparin-coated circuits do not show additive effects.
Disciplines :
Surgery
Author, co-author :
Defraigne, Jean-Olivier ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie générale
Pincemail, Joël ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie cardio-vasculaire
Larbuisson, Robert ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Blaffart, Francine ; Centre Hospitalier Universitaire de Liège - CHU > Bloc opératoire chirurgie cardio-vasculaire
Limet, Raymond ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique
Language :
English
Title :
Cytokine Release and Neutrophil Activation Are Not Prevented by Heparin-Coated Circuits and Aprotinin Administration
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