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Ann Thorac Surg 2008;86:1723. doi:10.1016/j.athoracsur.2008.05.029
© 2008 The Society of Thoracic Surgeons
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Correspondence

Complement Activation After Cardiac Surgery Follows a Biphasic Pattern

Cornelia W. Hoedemaekers, MD, PhD, Marcel van Deuren, MD, PhD, Johannes G. van der Hoeven, MD, PhD

Departments of Intensive Care and Internal Medicine, Radboud University Nijmegen Medical Centre, Geert Groteplein 10, Nijmegen, 6500 HB the Netherlands

(Email: c.hoedemaekers{at}ic.umcn.nl).

To the Editor:

We read with interest the article of Marcheix and colleagues [1] on the postoperative inflammatory response after cardiac surgery. The authors studied the effect of different techniques of processing pericardial blood on activation of the complement system after cardiopulmonary bypass (CPB). The authors found that at 30 and 240 minutes after CBP, concentrations of C3a, sC5b-9, and Bb were increased and C5a and MBL levels were decreased compared with preoperative levels.

It has been shown that complement activation after CBP follows a biphasic pattern [2]. In a recent study we measured complement components sC5b-9, C3bc, C3bBbP, C1rs-C1inh, MBL, and C4bc in patients after uncomplicated coronary artery bypass grafting until 24 hours after admission to the intensive care unit. We confirmed that complement activation shows a biphasic pattern. In the early postoperative phase, complement was activated mainly trough the classical and lectin pathway and was augmented by the alternative pathway, leading to the formation of C3bc and terminal complement complexes (Fig 1). After 8 hours, complement was activated by the classical and lectin pathway to the point of C3b formation without further production of terminal complement complexes, indicating inhibition beyond C3b. These results indicate that during the second phase, after 8 hours, the terminal pathway is efficiently inhibited, as we hypothesized by factor H bound to CRP-C1q complexes.


Figure 1
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  		Fig 1. Concentrations of terminal complement complex (TCC) and C3bc after uncomplicated coronary artery bypass grafting (CABG). Data are expressed as mean values. (ICU = intensive care unit.)

 
Marcheix and colleagues [1] measured concentrations of complement components until 4 hours after weaning from CPB. The effect of their intervention on the clinically important second phase of activation was not measured. Their conclusions on the beneficial effects of cell-saving devices on complement activation are potentially premature and should be interpreted with caution.


   References
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  1. Marcheix B, Carrier M, Martel C, et al. Effect of pericardial blood processing on postoperative inflammation and the complement pathways Ann Thorac Surg 2008;85:530-535.[Abstract/Free Full Text]
  2. Bruins P, te Velthuis H, Yazdanbakhsh AP, et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia Circulation 1997;96:3542-3548.[Abstract/Free Full Text]

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Bertrand Marcheix and Michel Carrier
Ann. Thorac. Surg. 2008 86: 1723. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., November 1, 2008; 86(5): 1723 - 1723.
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