Ann Thorac Surg 2005;79:1096
© 2005 The Society of Thoracic Surgeons
Correspondence
Markers of Endothelial Activation During Cardiopulmonary Bypass
Yoshio Misawa, MD
Division of Cardiovascular Surgery, Jichi Medical School, 3311-1 Yakushiji, Minami-kawachi, Tochigi 329-0498, Japan
(E-mail: tcvmisa{at}jichi.ac.jp).
To the Editor:
I read with great interest the report by Eikemo and associates [1]. The authors analyzed blood samples from 21 patients undergoing combined valve and coronary artery bypass grafting operations under moderate hypothermia (32°C). They concluded that endothelial cells were activated during cardiopulmonary bypass (CPB) and that the soluble adhesion molecules, eg, soluble endothelium-derived adhesion molecule-1 (intercellular adhesion molecule-1 or ICAM-1), displayed different kinetics, thus making it difficult to determine a simple expression for the degree of endothelial cell activation. The concentration of ICAM-1 increased after transfusion of blood from the heart-lung machine and on the first postoperative morning.
In 2000, my colleagues and I [2] reported the clinical results from 17 patients undergoing coronary artery bypass grafting under normothermic CPB. Levels of ICAM-1 and thrombomodulin were measured as markers of endothelial activation. Amounts of both ICAM-1 and thrombomodulin decreased during CPB, returned to initial levels 2 hours after CPB, and increased 24 hours after CPB. No difference was detected between heparin-bonded and non-heparin-bonded circuits.
Because ICAM-1 can be trapped in the oxygenator, the ICAM-1 value after CPB might not show the exact in vivo levels. As Eikemo and coauthors mentioned, patient age and other factors might influence ICAM-1 production, and the profiles of our patients were somewhat different from those of Eikemo and associates. However, both studies revealed similar clinical results implying that ICAM-1 is not a suitable marker to accurately detect the degree of endothelial cell activation caused by CPB.
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References
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- Eikemo H, Sellevold OFM, Videm V. Markers for endothelial activation during open heart surgery Ann Thorac Surg 2004;77:214-219.[Abstract/Free Full Text]
- Misawa Y, Kawahito K, Konishi H, Fuse K. Cytokine mediated endothelial activation during and after normothermic cardiopulmonary bypass: heparin-bonded versus non heparin-bonded circuits ASAIO J 2000;46:740-743.[Medline]
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