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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 978-987, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MC Seghaye, J Duchateau, RG Grabitz, ML Faymonville, BJ Messmer, K Buro- Rathsmann and G von Bernuth
Twenty-nine children 3 months to 17 years of age undergoing operations for
congenital heart disease were included in this prospective study.
Complement activation, activation of the plasma contact system, leukocytes,
leukocyte elastase release, and C-reactive protein were studied during and
after cardiopulmonary bypass for the first postoperative week and related
to multiple system organ failure occurring in eight (27.5%) of the 29
children. During cardiopulmonary bypass complement activation via the
alternative pathway as indicated by significant conversion of C3 (expressed
by C3d/C3) and abnormally high C5a values at the end of cardiopulmonary
bypass without consumption of C4 was shown in all children. At the end of
cardiopulmonary bypass, C3 conversion was significantly higher in the eight
patients with multiple system organ failure than in the others (p <
0.05), whereas no difference in C5a level was shown. All children had a
significant increase in leukocyte count directly after protamine
administration (p < 0.0001) and elastase release during cardiopulmonary
bypass that was significantly higher in patients with multiple system organ
failure than in those without (p < 0.05). Consumption of prekallikrein
as an indicator of activation of the Hageman system was not detectable
during cardiopulmonary bypass in any child. After cardiopulmonary bypass,
in patients without multiple system organ failure, C3d/C3 decreased and
reached preoperative values within the first postoperative week, whereas,
in patients with multiple system organ failure, C3d/C3 increased further,
reaching a maximal value on the third postoperative day. In comparison with
patients without multiple system organ failure, patients with multiple
system organ failure showed a severe decrease of C4 (with minimal values on
the third postoperative day), suggesting consumption by activation of the
classic pathway of the complement system or a hepatic synthesis deficiency.
Prekallikrein values were also significantly lower in patients with
multiple system organ failure than in the others, with a maximal difference
on the third postoperative day (p < 0.005). C- reactive protein was
significantly lower in patients with multiple system organ failure than in
the others for the first 2 postoperative days (p < 0.05), probably
because of severe hepatic failure in patients with multiple system organ
failure. This study demonstrates that, in children, cardiopulmonary bypass
induces complement activation principally via the alternative pathway. It
suggests a relationship between complement activation and multiple system
organ failure observed in the postoperative period. Furthermore, it points
out the role of multiple system organ failure itself on the C3 conversion
and on the synthesis of the markers of the inflammatory response in
children after heart operations.
ARTICLES
Complement activation during cardiopulmonary bypass in infants and children. Relation to postoperative multiple system organ failure
Department of Pediatric Cardiology, Hopital St. Pierre, Brussels, Belgium.
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S. Ashraf, J. Butler, Y. Tian, D. Cowan, S. Lintin, N. R. Saunders, K. G. Watterson, and P. G. Martin Inflammatory Mediators in Adults Undergoing Cardiopulmonary Bypass: Comparison of Centrifugal and Roller Pumps Ann. Thorac. Surg., February 1, 1998; 65(2): 480 - 484. [Abstract] [Full Text] [PDF]
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J. Sonntag, I. Dahnert, B. Stiller, R. Hetzer, and P. E. Lange Complement and Contact Activation During Cardiovascular Operations in Infants Ann. Thorac. Surg., February 1, 1998; 65(2): 525 - 531. [Abstract] [Full Text] [PDF]
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P. J. del Nido Myocardial Protection and Cardiopulmonary Bypass in Neonates and Infants Ann. Thorac. Surg., September 1, 1997; 64(3): 878 - 879. [Full Text]
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 A. J. du Plessis Topical Review: Cerebral Hemodynamics and Metabolism During Infant Cardiac Surgery. Mechanisms of Injury and Strategies for Protection J Child Neurol, August 1, 1997; 12(5): 285 - 300. [Abstract] [PDF]
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M.-C. Seghaye, J. Duchateau, R. G. Grabitz, J. Mertes, C. Marcus, K. Buro, B. J. Messmer, and G. von Bernuth HISTAMINE LIBERATION RELATED TO CARDIOPULMONARY BYPASS IN CHILDREN: POSSIBLE RELATION TO TRANSIENT POSTOPERATIVE ARRHYTHMIAS J. Thorac. Cardiovasc. Surg., May 1, 1996; 111(5): 971 - 981. [Abstract] [Full Text]
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M.-C. Seghaye, MD, J. Duchateau, R. G. Grabitz, T. Wolffb, C. Marcus, W. Engelhardt, H. Hornchen, B. J. Messmer, and G. von Bernuth EFFECT OF SODIUM NITROPRUSSIDE ON COMPLEMENT ACTIVATION INDUCED BY CARDIOPULMONARY BYPASS: A CLINICAL AND EXPERIMENTAL STUDY J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 882 - 892. [Abstract] [Full Text]
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M.-C. Seghaye, J. Duchateau, R. G. Grabitz, K. Jablonka, T. Wenzl, C. Marcus, B. J. Messmer, and G. von Bernuth Influence of Low-Dose Aprotinin on the Inflammatory Reaction Due to Cardiopulmonary Bypass in Children Ann. Thorac. Surg., April 1, 1996; 61(4): 1205 - 1211. [Abstract] [Full Text]
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M.-C. Seghaye, J. Duchateau, J. Bruniaux, S. Demontoux, C. Bosson, A. Serraf, G. Lecronier, E. Mokhfi, and C. Planche INTERLEUKIN-10 RELEASE RELATED TO CARDIOPULMONARY BYPASS IN INFANTS UNDERGOING CARDIAC OPERATIONS J. Thorac. Cardiovasc. Surg., March 1, 1996; 111(3): 545 - 553. [Abstract] [Full Text]
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D. F Larson, M. Bowers, and H W. Schechner Neutrophil activation during cardiopulmonary bypass in paediatric and adult patients Perfusion, January 1, 1996; 11(1): 21 - 27. [Abstract] [PDF]
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P. Menasche, J. Peynet, N. Haeffner-Cavaillon, M.-P. Carreno, T. de Chaumaray, V. Dillisse, B. Faris, A. Piwnica, G. Bloch, and A. Tedgui Influence of Temperature on Neutrophil Trafficking During Clinical Cardiopulmonary Bypass Circulation, November 1, 1995; 92(9): 334 - 340. [Abstract] [Full Text]
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F. Le Deist, P. Menasche, C. Kucharski, A. Bel, A. Piwnica, and G. Bloch Hypothermia During Cardiopulmonary Bypass Delays but Does Not Prevent Neutrophil– Endothelial Cell Adhesion : A Clinical Study Circulation, November 1, 1995; 92(9): 354 - 358. [Abstract] [Full Text]
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G. Wernovsky, D. Wypij, R. A. Jonas, J. E. Mayer Jr, F. L. Hanley, P. R. Hickey, A. Z. Walsh, A. C. Chang, A. R. Castaneda, J. W. Newburger, et al. Postoperative Course and Hemodynamic Profile After the Arterial Switch Operation in Neonates and Infants : A Comparison of Low-Flow Cardiopulmonary Bypass and Circulatory Arrest Circulation, October 15, 1995; 92(8): 2226 - 2235. [Abstract] [Full Text]
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M.-C. Seghaye, J. Duchateau, R. G. Grabitz, G. Nitsch, C. Marcus, B. J. Messmer, and G. von Bernuth Complement, leukocytes, and leukocyte elastase in full-term neonates undergoing cardiac operation J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 29 - 36. [Abstract] [Full Text]
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