|Reference : Cytokine Release and Neutrophil Activation Are Not Prevented by Heparin-Coated Circuits ...|
|Scientific journals : Article|
|Human health sciences : Surgery|
|Cytokine Release and Neutrophil Activation Are Not Prevented by Heparin-Coated Circuits and Aprotinin Administration|
|Defraigne, Jean-Olivier [Université de Liège - ULg > 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 - ULg > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique]|
|Annals of Thoracic Surgery|
|[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.|
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