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The Annals of Thoracic Surgery, Vol 46, 47-57, Copyright © 1988 by The Society of Thoracic Surgeons
T Tamiya, M Yamasaki, Y Maeo, T Yamashiro, S Ogoshi and S Fujimoto
Complement activation by cardiopulmonary bypass (CPB) was studied in 82
patients divided into membrane (MOG) and bubble oxygenator groups (BOG).
The influence of primed homologous to circulating autologous blood volume
(H/A) ratio was also evaluated. C4a increased very slowly during CPB in
both groups, maintaining slightly higher levels in the BOG than in the MOG,
with the exception of a marked initial rise in the BOG with a high H/A
ratio (greater than or equal to 20%). Anaphylatoxin C3a levels increased
more steeply in the BOG than in the MOG. An obvious rise in anaphylatoxin
C5a production was observed in the BOG alone. The influence of high H/A
ratio perfusion on complement activation was milder in the MOG than in the
BOG. In 20 monkeys (Macaca fascicularis), continuous intraaortic infusion
with bubbled autologous blood increased C4a and C3a levels, while
autologous blood extracorporeally contacted with nylon increased C3a levels
alone. In vitro studies revealed that human immunoglobulin fractions
denatured by oxygen bubbling produced C4a, C3a, and C5a in a dose-dependent
manner, although human albumin treated identically as human immunoglobulin
did not produce these complements. It was thus inferred that (1) during
CPB, complement is predominantly activated via the classical pathway in the
BOG and via the alternative pathway in the MOG; (2) higher anaphylatoxin
levels in the BOG than in the MOG are related to mode and grade of blood
trauma; (3) anaphylatoxin level differences in both groups tend to increase
with high H/A perfusion; and (4) immunoglobulin- free sera may reduced
classical pathway activation.
ARTICLES
Complement activation in cardiopulmonary bypass, with special reference to anaphylatoxin production in membrane and bubble oxygenators
Second Department of Surgery, Kochi Medical School, Japan.
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