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Ann Thorac Surg 1998;66:1469
© 1998 The Society of Thoracic Surgeons

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Correspondence

Circulating adhesion molecules in cardiac surgical patients

^a Department of Cardiothoracic Surgery, St. Luke’s Hospital, G’Mangia, Malta
^b Department of Paediatrics, University of Sheffield, Sheffield, United Kingdom

e-mail: josegale{at}orbit.net.mt

To the Editor

In the March 1998 issue of The Annals of Thoracic Surgery, Boldt and colleagues demonstrated [1] that levels of circulating adhesion molecules increase significantly after coronary artery bypass grafting but not after pneumonectomy or Whipple’s pancreaticoduodenectomy.

In a similar study [2], we found the same trend with some differences. In 7 patients undergoing uncomplicated coronary artery bypass grafting we studied circulating intercellular adhesion molecule-1 (ICAM-1) and soluble E-selectin levels throughout cardiopulmonary bypass (CPB) and up to 48 hours after the operation. We measured plasma levels of these soluble adhesion molecules at eight time points: before the institution of, during, and at the end of CPB and at 1, 2, 3, 24, and 48 hours after the operation. Boldt and colleagues did not study the plasma levels during their prolonged surgical procedure and consequently did not report on circulating adhesion molecule behavior during CPB. We showed that the plasma levels of ICAM-1 and E-selectin decrease significantly during CPB even when corrected for hemodilution. Subsequently the levels of circulating ICAM-1 and E-selectin did not rise as high nor as early as those described in the study by Boldt and associates, circulating ICAM-1 levels reaching a statistically significant increase compared with the pre-CPB level at 24 hours after operation and soluble E-selectin levels never reaching a statistically significant increase. These differences may be the result of a more intense endothelial injury in the study reported in The Annals, in which CPB times were significantly longer (101.8 ± 14.4 minutes compared with 73.9 ± 4 minutes in our study). Normothermic bypass (33° to 37°C) has been shown to be associated with increased plasma levels of circulating ICAM-1 compared with hypothermic bypass (28° to 30°C) [3]. The core temperature was kept greater than 35°C in the study by Boldt and associates, whereas our patients were maintained at 32°C during CPB.

In conclusion, our study highlights the benefits of shorter CPB at 32°C as evidenced by a lesser rise in levels of circulating adhesion molecules.

References

1. Boldt J., Kumle B., Papsdorf M., Hempelmann G. Are circulating adhesion molecules specifically changed in cardiac surgical patients?. Ann Thorac Surg 1998;65:608-614.[Abstract/Free Full Text]
2. Galea J., Rebuck N., Finn A., Manché A., Moat N. Expression of soluble endothelial adhesion molecules in clinical cardiopulmonary bypass. Perfusion 1998;13:314-321.[Abstract/Free Full Text]
3. Menasché P., Peynet J., Lariviére J., et al. Does normothermia during cardiopulmonary bypass increase neutrophil-endothelium interactions?. Circulation 1994;90(Suppl 2):275-279.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph L. Galea Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Galea, J. L. Articles by Finn, A. R. Search for Related Content PubMed Articles by Galea, J. L. Articles by Finn, A. R.