Abstract
Open aortic surgery evokes a systemic inflammatory response and is associated with high morbidity and mortality. Purinergic signaling has been shown to be crucial for maintaining vascular integrity and attenuating inflammation related to hypoxia. The involvement of purinergic signaling in cross clamping of major human arteries is unknown. Our aim was to compare systemic inflammatory responses and hypoxia-induced purinergic signaling in patients undergoing either open infra-renal abdominal aortic repair or infra-inguinal revascularization. Pre- and 24 h post-operative blood samples were gathered from 6 patients undergoing aortic clamping and 6 similar patients undergoing common femoral artery cross-clamping. Using Biorad Multipex™ 21- and 27-panels 48 different cytokines, chemokines and growth factors were analyzed, in addition to circulating levels of ATP, ADP, CD39, CD73 and HIF-1α, and compared between the groups. Several inflammatory cytokines were elevated from baseline levels after aortic clamping, but not after femoral cross clamping. Most pronoun rises were seen in IL-6 (667 %, P = 0.016) and HGF (760 %, P = 0.016). HIF-1α values showed a steady increase after clamping of either artery unless the subject underwent blood transfusion. Despite an adequate increase in HIF-1α CD39 and CD73 activity decreased significantly after aortic clamping (P = 0.047 and P = 0.016, respectively). Aortic clamping is associated with a clear and strong systemic inflammatory response and impaired repair mechanisms in terms of purinergic signaling. Patients undergoing open aorta repair could benefit from pre-operative medical therapy, which enhances CD73 expression.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1651-x) contains supplementary material, which is available to authorized users.
Highlights
Acute organ injury remains one of the leading causes of morbidity and mortality in surgical patients (Eltzschig 2013)
Discussion of results This study clearly shows that open infra-renal aorta repair significantly elevates levels of several circulating cytokines and growth factors, but in particular IL-6 and hepatocyte growth factor (HGF)
Open infra-renal aorta repair is associated with a systemic inflammatory response, but in addition according to the present study an impaired CD39 and CD73 response to attenuate inflammation
Summary
Acute organ injury remains one of the leading causes of morbidity and mortality in surgical patients (Eltzschig 2013). A highlight of such surgery is open aortic cross clamping and reconstruction, which is associated with a systemic inflammatory response syndrome (SIRS) (Bown et al 2001; Vasdekis et al 2008) and dysfunction of central organs, especially the lungs, kidneys and intestine (Brady et al 2000; Papia et al 2006; Moris et al 2014). The current background literature of this pathway is mostly derived from animal studies, in which cross-clamping of central arteries has been widely used to provoke reperfusion injury and a systemic inflammatory response in order to study different organ failures (Grenz et al 2007; Kiss et al 2007; Hart et al 2011)
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