Elastase release following myocardial ischemia during extracorporeal circulation (ECC) -- marker of ongoing systemic inflammation?

'Post-Perfusion Syndrome' (PPS) after cardiopulmonary bypass (CPB) is known to be evoked by inflammatory reactions. The hypothesis of a pathogenetic role for the neutrophil granulocytes in this inflammation would be strengthened if elevated concentrations of a neutrophil product such as elastase could be demonstrated, particularly in case of a PPS or a systemic inflammatory response syndrome (SIRS). In a randomized prospective double-blind study, 40 patients undergoing aortocoronary bypass grafting (CABG) were divided into 4 groups of 10 patients each. One group served as the control group, one received prostacyclin (PGl 2 ), the third group was substituted with high-dosed aprotinin and the last group was treated with a combination of PGl 2 and aprotinin. 6 blood samples were taken from every patient perioperatively, and plasma elastase (PE), procalcitonin (PCT), C 1 -esterase inhibitor (CEI) and parameters of coagulation and fibrinolysis were determined. Levels of elastase increased significantly in all intra- and postoperative blood samples compared to the preoperative baseline values (< 30 microg/l, p < 0.05). The elastase release was even more pronounced in the control and aprotinin group (170 +/- 23 microg/l; 175 +/- 14 mi...Continue Reading