Polymorphonuclear cells (PMNs) activation and on line pmns removal during extracorporeal circulation for open heart surgery

COMPLEMENT ACTIVATION IN STABLE VERSUS UNSTABLE ANGINA PATIENTS UNDERGOING AORTOCORONARY BYPASS SURGERY U Schott, E Hagberg, J Svensson Departments of Anesthesia and Intensive Care and Thoracic Surgery, brebro 70185 Crebro Sweden

Introduction, Patients with myocardial infarction or unstable angina can have increased levels of C3a-desArg as a sign of activation of the complement system (1). No comparison of complement activation in patients with stable versus unstable angina pectoris have been performed during cardiopulmonary surgery. Patients and methods, 8 patients with unstable angina (preoperative heparin infusion), but with no infarction signs on a standard 5-lead electrocardiogram and with no enzyme leakage (CKMB) were compared to 8 patients with stable angina pectoris. Patients with low preoperative antithrombin III (~80%) were not included. Membrane oxygenators (Dideco, Italy (4 in each group) and Maxima (Medtronic), USA (4 in each group) and continous flow with a Stocker-t Shiley, Germany were used for ECC. Complement activation was measured as plasma levels of desarginated activated C3a, ie C3adesArg (@ml) with a radioimmunoassay method (Upjohn). Blood was sampled from the arterial line preoperatively (P), before heparinisation (bh), after heparinisation (ah), 5 minutes after start of extracorporeal circulation (53, 15’, 30’ and 60 min after start of ECC, after finish of ECC (F), 1 hour after (1 h), 3 h and 18 h after protamine reversal. Hematocrii, routine hematology, Sonoclot coagulation analyses (Sienco, USA) and routine coagulation analyses were performed. Postoperative hourly blood losses and hemodynamics including left arterial pressure were measured. Results, there was no difference in demographic data, hematocrit, protamine dose, time of ECC, time of aortic clamping or in hemodynamics between the groups. Total dose of heparin was significantly higher in patients with unstable angina and Sonoclot indicated a hypercoagulative response in this group. Leucocyte count was significantly lower (p
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Journalof

Medical Center Hospital,

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Discussion, patients with unstable angina pectoris had a different complement activation pattern than patients with stable angina pectoris undergoing ACB. Unstable angina patient were activated already preoperatively. Preoperative heparininfusion? Hypercoagulation? These patients seemed to have exhausted the complement system, considering the significant increase in C3a-desArg (intragroup analysis) during ECC in stable angina patients. A difference in clearance of C3a-desArg is also a probable mechanism, due to the higher postoperative C3adesArg plasma levels in the unstable angina patients. The clinical relevance of the increased pre- and postoperative plasma levels of C3a-desArg remains to be more thoroughly studied. Reference, (1) Kirklin J K, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg (86):845857,1 983

Cardiothoracic EACTA

and

Vascular

94 Abstracts:

Anesthesia, Cardiovascular

Vol 8. No 5, Suppl Pharmacology

3 (October),

1994