Inflammatory Response to Cardiopulmonary Bypass

Mechanisms Involved and Possible Therapeutic Strategies

¹ From the Department of Cardiac Surgery, University Hospital Erasme, Free University of Brussels, Brussels, Belgium
² From the Department of Intensive Care, University Hospital Erasme, Free University of Brussels, Brussels, Belgium

Background: Recent study of the inflammatory reactions occurring during and after cardiopulmonary bypass (CPB) has improved our understanding of the involvement of the inflammatory cascade in perioperative injury. However, the exact mechanisms of this complex response remain to be fully determined.

Methods: Literature on the inflammatory response to CPB was reviewed to define current knowledge on the possible pathways and mediators involved, and to discuss recent developments of therapeutic interventions aimed at attenuating the inflammatory response to CPB.

Results: CPB has been shown to induce complement activation, endotoxin release, leukocyte activation, the expression of adhesion molecules, and the release of many inflammatory mediators including oxygen-free radicals, arachidonic acid metabolites, cytokines, platelet-activating factor, nitric oxide, and endothelins. Therapies aimed at interfering with the inflammatory response include the administration of pharmacologic agents such as corticosteroids, aprotinin, and antioxidants, as well as modification of techniques and equipment by the use of heparin-coated CPB circuits, intraoperative leukocyte depletion, and ultrafiltration.

Conclusions: Improved understanding of the inflammatory reactions to CPB can lead to improved patient outcome by enabling the development of novel therapies aimed at limiting this response.

Key Words: antioxidants • aprotinin • cardiac surgery • complement • corticosteroids • cytokine • endothelin • endotoxin • inflammatory response • heat shock • heparin • leukocyte • ultrafiltration

Submitted on January 3, 1997
Accepted on March 31, 2007