Mast cell activation and arterial hypotension during proximal aortic repair requiring hypothermic circulatory arrest.
Mast cell activation and arterial hypotension during proximal aortic repair requiring hypothermic circulatory arrest.
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DOI：
10.1016/j.jtcvs.2016.05.063
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Karhausen JA
中科院分区：
文献类型：
--
作者：
Kertai MD;Cheruku S;Qi W;Li YJ;Hughes GC;Mathew JP;Karhausen JA
Aortic surgeries requiring hypothermic circulatory arrest evoke systemic inflammatory responses that often manifest as vasoplegia and hypotension. Because mast cells can rapidly release vasoactive and pro-inflammatory effectors, we investigated their role in intraoperative hypotension. We studied 31 patients undergoing proximal aortic repair with hypothermic circulatory arrest between June 2013 and April 2015 at Duke University Medical Center. Plasma samples were obtained at different intraoperative time-points to quantify chymase, IL6, IL8, TNFa, and white blood cell CD11b expression. Hypotension was defined as the area [minutes * mmHg] below a mean arterial pressure of 55 mmHg. Biomarker responses and their association with intraoperative hypotension were analyzed by two sample t test and Wilcoxon rank sum test. Multivariable logistic regression analysis was used to examine the association between clinical variables and elevated chymase levels. Mast cell-specific chymase increased from a median 0.97 [interquartile range, 0.01 to 1.84] pg/mg plasma protein at baseline to 5.74 [2.91 to 9.48] pg/mg plasma protein after instituting cardiopulmonary bypass, 6.16 [3.60 to 9.41] pg/mg plasma protein after completing of circulatory arrest and 7.64 [4.63 to 12.71] pg/mg plasma protein after weaning from cardiopulmonary bypass (each p<0.0001 vs baseline). Chymase was the only biomarker associated with hypotension during (p = 0.0255) and after cardiopulmonary bypass (p = 0.0221). Increased temperatures at circulatory arrest and low pre-surgical hemoglobin levels were independent predictors of increased chymase responses. Mast cell activation occurs in cardiac surgery requiring cardiopulmonary bypass and hypothermic circulatory arrest and is associated with intraoperative hypotension.
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