Forty patients undergoing CPB for coronary artery surgery, using a standardized technical setting, were randomized to receive either Ringer's acetate, dextran 70 (Macrodex), polygeline (Haemaccel) or albumin 4% for volume replacement during and after surgery. The choice of fluid did not affect early complement activation (C3 activation products). Higher values of the terminal complement complex (TCC) were found only at the end of the operation in patients receiving polygeline. There were no differences between any two of the four groups during the postoperative course. The use of blood transfusion or autotransfusion and the degree of haemodilution and hypothermia did not affect complement activation.
We conclude that complement activation in association with open-heart surgery is only marginally affected by the choice of fluid for volume replacement.
Get full access to this article
View all access options for this article.
References
1.
Chenoweth DE , Cooper SW, Hugli TE, Stewart RW, Blackstone EH, Kirklin JWComplement activation during cardiopulmonary bypass. Evidence for generation of C3a and C5a analphylatoxins . N Engl J Med1981; 304: 497-503.
2.
Kirklin JK, Westaby S., Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico ADComplement and damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg1983; 86: 845-57.
3.
Fosse E., Mollnes TE, Ingvaldsen B.Complement activation during major operations with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg1987; 93: 806-66.
4.
Nilsson L., Brunnkvist S., Nilsson U. et al. Activation of inflammatory system during cardiopulmonary bypass. Scand J ThorCardiovasc Surg1988; 22: 51-53.
5.
Videm V., Fosse E., Mollnes TE, Karlsen H., Pedersen T., Garred P.Complement activation induced by different tubings used for cardiopulmonary bypass. J Extracorpor Tech1989; 21: 20-33.
6.
Mellbye OJ, Frøland SS, Lilleaasen P., Svennevig JL, Mollnes TEComplement activation during cardiopulmonary bypass: comparison between the use of large volumes of plasma and dextran 70. Eur Surg Res1988; 20: 101-109.
7.
Bonser RS, Dave JR, Davies ET et al. Reduction of complement activation during bypass by prime manipulation . Ann Thorac Surg1990; 49: 279-83.
8.
Videm V., Mollnes TEHuman complement activation by polygeline and dextran 70. Scand J Immunol1994; 39: 314-20.
9.
Videm V., Fosse E., Mollnes TE, Garred P.Complement activation by extracorporeal circulation: effects of precoating a membrane oxygenator circuit with human whole blood. Scand J Thorac Cardiovasc Surg1988; 22: 251-56.
10.
Videm V., Svennevig JL, Fosse E., Semb G., Østerud A., Mollnes TEReduced complement activation with heparin coated oxygenators and tubings in coronary bypass surgery. J Thorac Cardiovasc Surg1992; 103: 806-13.
11.
Garred P., Mollnes TE, Lea T.Quantification in ELISA of a C3 neoepitope expressed on activated human complement factor C3. Scand J Immunol1988; 27: 329-35.
12.
Mollnes TE, Lea T., Frøland SS, Harboe M.Quantification of the terminal complement complex in human plasma by an enzyme-linked immunosorbent assay based on monoclonal antibodies against neoantigen on the complex. Scand J Immunol1985; 22: 197-202.
13.
Laks H., Standeven J., Blair O., Hahn J., Jellinek M., Willman VLThe effects of cardiopulmonary bypass with crystalloid and colloid hemodilution on myocardial extravascular water. J Thorac Cardiovasc Surg1977; 73: 129-37.
14.
Karenko MS, Klossner JA, Laaksonen VORestoration of volume by crystalloid versus colloid after coronary artery bypass: hemodynamics, lung water, oxygenation, and outcome. Crit Care Med1987; 15: 559-66.
15.
Ley SJ, Miller K., Skov P., Preisig P.Crystalloid versus colloid fluid therapy after cardiac surgery. Heart Lung1990; 19: 31-40.
16.
Tamiya T., Yamasaki M., Maeo Y., Yamashiro T., Ogoshi S., Fujimoto S.Complement activation during cardiopulmonary bypass: attenuation by hypothermia, heparin, and hemodilution. Ann Surg1988; 208: 95-193.
17.
van Oeveren W., Kazatchkene MD, Descamps-Latscha B. et al. Deleterious effects of cardiopulmonary bypass. A prospective study of bubble versus membrane oxygenation . J Thorac Cardiovasc Surg1985; 89: 888-99.
18.
Videm V., Fosse E., Mollnes TE, Garred P., Svennevig JLComplement activation with bubble and membrane oxygenators in aortocoronary bypass surgery. Ann Thorac Surg1990; 50: 387-91.
19.
Kongsgaard UE, Smith-Erichsen N., Geiran O., Bjørnskau L.Duration of cardiopulmonary bypass compared with changes in the plasma protease systems . Scand J Thorac Cardiovasc Surg1991; 25: 223-26.
Moore FD, Warner KG, Assousa S., Valeri CR, Khuri SFThe effects of complement activation during cardiopulmonary bypass: attenuation by hypothermia, heparin, and hemodilution. Ann Surg1988; 208: 95-103.
22.
Mickleborough LL, Arnold G., Chiu RCComplement consumption during cardiopulmonary bypass: bubble versus membrane oxygenators. Perfusion1986; 1: 261-69.
