This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bruins, P. Articles by Hack, C. E. Search for Related Content PubMed PubMed Citation Articles by Bruins, P. Articles by Hack, C. E. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Arrhythmia Coronary Artery Bypass Surgery

(Circulation. 1997;96:3542-3548.)
© 1997 American Heart Association, Inc.

Articles

Activation of the Complement System During and After Cardiopulmonary Bypass Surgery

Postsurgery Activation Involves C-Reactive Protein and Is Associated With Postoperative Arrhythmia

Peter Bruins, MD; Henk te Velthuis, PhD; Aria P. Yazdanbakhsh; Piet G. M. Jansen, MD, PhD; Fred W. J. van Hardevelt; Eddy M. F. H. de Beaumont, MD; Charles R. H. Wildevuur, MD, PhD; León Eijsman, MD, PhD; Ad Trouwborst, MD, PhD; ; C. Erik Hack, MD, PhD

From the Departments of Anaesthesiology (P.B., E.M.F.H. de B., A.T.) and Cardiopulmonary Surgery (A.P.Y., P.G.M.J., F.W.J. van H., C.R.H.W., L.E.), Academic Medical Centre, Amsterdam, and the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service and Laboratory for Experimental and Clinical Immunology, University of Amsterdam, Academic Medical Centre (H. te V., C.E.H.), Amsterdam, the Netherlands.

Correspondence to P. Bruins, MD, Academic Medical Centre, Department of Anaesthesiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.

Background Complement activation during cardiopulmonary bypass (CPB) surgery is considered to result from interaction of blood with the extracorporeal circuit. We investigated whether additional mechanisms may contribute to complement activation during and after CPB and, in particular, focused on a possible role of the acute-phase protein C–reactive protein (CRP).

Methods and Results In 19 patients enrolled for myocardial revascularization, perioperative and postoperative levels of complement activation products, interleukin-6 (IL-6), CRP, and complement-CRP complexes, reflecting CRP-mediated complement activation in vivo, were measured and related to clinical symptoms. A biphasic activation of complement was observed. The ratio between the areas under the curve of perioperative and postoperative C3b/c and C4b/c were 3:2 and 1:46, respectively. IL-6 levels reached a maximum at 6 hours post-surgery. CRP levels peaked on the second postoperative day. Each complement-CRP complex had peak levels on the second or third postoperative day. By multivariate analysis, maximum levels of CRP on the second postoperative day were mainly explained by C4b/c levels after protamine administration, leukocyte count on the second postoperative day, and preoperative levels of CRP. Peak levels of C4b/c after protamine administration (P=.0073) and on the second postoperative day correlated with the occurrence of arrhythmia on the same day (P=.0065).

Conclusions Cardiac surgery with CPB causes a biphasic complement activation. The first phase occurs during CPB and results from the interaction of blood with the extracorporeal circuit. The second phase, which occurs during the first 5 days after surgery, involves CRP, is related to baseline CRP levels, and is associated with clinical symptoms such as arrhythmia.

Key Words: proteins • complement • interleukins • extracorporeal circulation • arrhythmia