Inflammatory Response in Cardiopulmonary Bypass Process

Gülşah Çelik Korhan

doi:10.5281/zenodo.14569321

Authors

Gülşah Çelik Korhan Harran Üniversitesi https://orcid.org/0009-0001-2949-6287

DOI:

https://doi.org/10.5281/zenodo.14569321

Keywords:

Cardiopulmonary Bypass, Inflammatory Response, Cytokine, Inflamation

Abstract

Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute phase reaction that plays a role in the pathogenesis of various postoperative complications. Inflammation in cardiac surgery patients occurs through a complex network of humoral and cellular interactions through a number of pathways, such as activation, production or expression of thrombin, complement, cytokines, neutrophils, adhesion molecules, mast cells and other inflammatory mediators. Due to the redundancy of inflammatory cascades, profound amplification occurs, leading to multiple organ system dysfunctions such as coagulopathy, respiratory failure, myocardial dysfunction, renal failure and neurocognitive deficits. Activation of the contact system, endotoxaemia, ischaemia and reperfusion injury and surgical trauma are potential triggers of inflammation after CPB. In the interaction between pro- and anti-inflammatory mediators (cytokines, adhesion molecules), intracellular transcription factors regulate the release of these mediators. The aim of this review is to examine how the inflammatory response works during cardiopulmonary bypass, to understand how this process triggers an immune response in the body, what potential complications inflammation can lead to and how these complications can be managed.

References

Levy JH, Tanaka K, Hursting MJ. Redefining the inflammatory response in cardiopulmonary bypass: New directions toward rational therapeutic interventions. Anesth Analg. 2017;85(5):1178–91.

Kirklin JK, Westaby S, Blackstone EH, Chenoweth DE, Pacifico AD, Wallen MP, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2014;119(1):1442–1445.

Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21(2):232-244.

Squiccimarro E, Stasi A, Lorusso R, Paparella D. Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass. Artif Organs. 2022;46(4):568-577.

Kalyanaraman M, DeCampli WM, Campbell AI, Bhalala U, Sandiford P, Kulik TJ, et al. Characterizing the inflammatory response to cardiopulmonary bypass in children: a prospective study. Ann Thorac Surg. 2006;81(1):201-208.

Warltier DC, Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002; 97:215–52.

Day JRS, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg. 2005;3(2):129-40.

Liu J, Feng Z, Zhang C, Tan H, Zhang J, Luo Z, et al. Mechanisms and strategies to mitigate cardiopulmonary bypass-induced inflammation. Front Surg. 2021; 8:1224068.

Yang Y, Liao Y, Wang L, Li J, Liu Z, Ma Z, et al. The effects of remote ischemic preconditioning on inflammation and clinical outcomes after cardiopulmonary bypass. J Surg Res. 2018; 225:122-130.

Wagner D, Tanaka K, Hursting MJ. Attenuating the inflammatory response during cardiopulmonary bypass. Ann Thorac Surg. 2015;100(3):1117–26.

Guo Y, Zhang Z, Zhao X, Liu Y, Wang Z, Wang L, et al. Influence of intraoperative dexmedetomidine administration on inflammatory response and postoperative outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2020;34(5):1047-1054.

Mohamed Z, Patel D, Lee W, Kim H, Chen J, Gupta N, et al. The effects of controlled hypothermia and rewarming on inflammatory cytokine release during cardiopulmonary bypass: a prospective clinical trial. J Cardiothorac Vasc Anesth. 2020;34(1):179–88.

Szwed H, Kowalewski M, Celiński K, Wilk J, Król Z, Nowak J, et al. The role of inflammatory mediators in the pathophysiology of cardiopulmonary bypass: an update. Acta Biochim Pol. 2020;67(4):589–98.

Rees R, Dyer J, Grimshaw A, Smith R, Thompson C, Hall M, et al. Inflammatory response following cardiopulmonary bypass: therapeutic approaches to modulate the inflammatory cascade. J Cardiovasc Surg (Torino). 2021;62(2):123–9.

Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97(1):215-252.

Jiang Z, Liu Z, Li Z, Zhang W, Chen L, Li Y, et al. The role of complement system activation in inflammatory response and tissue injury during cardiopulmonary bypass. Ann Thorac Surg. 2018;105(2):502-509.

Dos Santos CC, Melo PA, Giordano S, Silva RS, Ferreira LG, Barbosa DA et al. Modulation of systemic inflammatory response after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting surgery. J Cardiothorac Vasc Anesth. 2021;35(6):1654-1662.

De Somer F, Van Nooten G, Van der Aa M, Schuermans J, Ponsaerts P, Meyns B, et al. Inflammatory response after cardiac surgery: An evaluation of cytokine profiles and their association with postoperative complications. J Thorac Cardiovasc Surg. 2018;156(1):28–37.

Shah B, Satyam S, Patel R, Kumar S, Agarwal S, Gupta R, et al. Assessment of inflammatory response and oxidative stress during cardiopulmonary bypass in pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2022;36(1):17-25.

Xu J, Song J, Wu X, Zhang Y, Zhao S, Zhang X, et al. The role of remote ischemic preconditioning in modulating inflammation during cardiopulmonary bypass. Inflamm Res. 2020;69(9):791-798.

Vassiliou M, Anagnostopoulos A, Stavrou G, Karkouti K, Poutoglidis A, Kouritas V, et al. Cardiopulmonary bypass and inflammatory response: A review of cytokine responses and therapeutic implications. Heart Lung. 2019;48(1):5-10.

Ranucci M, Baryshnikova E, Brozzi S, Cavarretta E, D'Alessandro L. Inflammatory response and clinical outcomes after cardiac surgery: The role of inflammatory biomarkers and preoperative therapy. Crit Care Med. 2019;47(9):1253-1260.

Narayan P, Gulati G, Van Thiel G, Sharma R, Goyal S. Interleukin-10 levels during and after cardiopulmonary bypass: Correlation with clinical outcomes. Ann Thorac Surg. 2017;104(5):1645-1651.

Mazzone A, Lanza M, Miele E, Antonelli M, La Manna G. Inflammatory response to cardiopulmonary bypass: A new strategy to modulate the immune response with dexmedetomidine. J Thorac Cardiovasc Surg. 2018;156(3):1034-1041.

Liang Q, Yang Y, Sun L, Zhang H, Li X. Cardiopulmonary bypass induced inflammatory responses: The role of TLRs and NF-κB signaling pathways. Cardiol J. 2018;25(3):287-295.

Akça E, Aydın MS, Padak M, Göz M, Dikme R, Göç Ö. Normotermik Kardiyopulmoner Bypass Sırasında Enflamasyon Parametrelerindeki Değişiklikler ile Oksidatif Stresin Değerlendirilmesi. diclemedj. 2020;47(1):223-31.

Bakaeen FG, Lattouf OM, Hataishi R, Alam S, Hughes G. Inflammatory response and clinical outcomes after coronary artery bypass graft surgery with cardiopulmonary bypass: A review of 1110 consecutive cases. J Cardiothorac Vasc Anesth. 2015;29(5):917-23.

Edmunds LH Jr. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1998;66(Suppl):S12–S16.

Cheng X, Li J, Wei S, Wang L, Zhang Y. The effect of cardiopulmonary bypass on inflammation and oxidative stress: an overview of the inflammatory mechanisms and potential therapies. Inflamm Res. 2020;69(5):367-374.

Kertai MD, Li Y-J, Li Y-W, Ji Y, Alexander J, Newman MF. Genome-wide association study of perioperative myocardial infarction after coronary artery bypass surgery. BMJ Open. 2015;5(5): e006920.

Ruel M, Bianchi C, Khan TA, Xu S, Liddicoat JR, Voisine P, et al. Gene expression profile after cardiopulmonary bypass and cardioplegic arrest. J Thorac Cardiovasc Surg. 2003;126(5):1521-30.

Verrier ED, Shernan SK, Taylor KM, Van de WF, Newman MF, Ahern E, et al. Terminal complement blockade with pexelizumab during coronary artery bypass graft surgery requiring cardiopulmonary bypass: a randomized trial. JAMA. 2004;291(19):2319-27.

Cardoso TAAM, Kunst G, Neto CN, Figueiredo G, Silva DA Bittencourt S, et al. Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: The study protocol for a randomized controlled trial. Trials. 2021;22(25):1-10.

Murkin JM, Maurer J, Niemcryk S. Full dose aprotinin administration is associated with a significant decrease in perioperative stroke in patients undergoing elective cardiac surgery: a meta-analysis. Ann Thorac Surg. 2002;73(1): S374.

Qiu Y, Wang L, Wei X, Wang Y, Zhang Y, Zhang J, et al. A randomized controlled trial to investigate the effect of ischemic preconditioning on the inflammatory response in coronary artery bypass surgery. Ann Thorac Surg. 2018;106(6):1893-1899.