Perioperative Immunity, Inflammatory Response, and Postoperative Infection in Cardiopulmonary Bypass Patients

Abstract

Open-heart surgery is a unique form of surgical trauma, as it superimposes the additional effects of cardiopulmonary bypass and hypothermia on conventional operative injury. Since the first open-heart operations, cardiopulmonary bypass (CPB) has been known to contribute to the mortality and morbidity of cardiac surgery. Although modern cardiopulmonary bypass seems to be well tolerated, it can never be truly physiological. During cardiopulmonary bypass, poor tissue perfusion and ischemic damage to the bowel mucosa may result in the translocation of endotoxin and enteric gram-negative bacteria from the gut [1, 2]. Thus, cardiopulmonary bypass patients are at risk for the development of postoperative infections and a “whole-body inflammatory response” resembling septic shock, the so-called post-perfusion syndrome [3].