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Ann Thorac Surg 1992;54:744-748
© 1992 The Society of Thoracic Surgeons
a Department of Cardiopulmonary Surgery Research Division, University Hospital Groningen, The Netherlands
b Department of Anesthesiology and Cardio-Pulmonary Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Accepted for publication February 21, 1992.
* Address reprint requests to Dr van Oeveren, Department of Cardiopulmonary Surgery Research Division, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.
Endotoxin, when released into the systemic circulation during cardiopulmonary bypass (CPB), might induce activation of plasmatic systems and blood cells during CPB, in addition to a material-dependent blood activation during CPB. However, the role of endotoxin in the development of this so-called whole-body inflammatory reaction in CPB is still unclear. We investigated the release of endotoxin into the systemic circulation in relation with the activation of the complement system and in particular the formation of tumor necrosis factor in 10 patients undergoing CPB. Immediately after the start of CPB the endotoxin concentrations increased significantly (p < 0.01), accompanied by increases in C3a concentration (p < 0.05). After release of the aortic cross-clamp, there was a second increase in endotoxin followed by a continuous increase in tumor necrosis factor, reaching a peak concentration 1 hour after the end of CPB (p < 0.01). These observations demonstrate a release of endotoxin into the systemic circulation associated with tumor necrosis factor formation, which contributes to the whole-body inflammatory reaction associated with CPB.
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