Mast cell activation and arterial hypotension during proximal aortic repair requiring hypothermic circulatory arrest.
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OBJECTIVE: 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 proinflammatory effectors, we investigated their role in intraoperative hypotension. METHODS: 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, interleukin-6, interleukin-8, tumor necrosis factor alpha, and white blood cell CD11b expression. Hypotension was defined as the area (minutes × millimeters mercury) below a mean arterial pressure of 55 mm Hg. Biomarker responses and their association with intraoperative hypotension were analyzed by 2-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. RESULTS: Mast cell-specific chymase increased from a median 0.97 pg/mg (interquartile range [IQR], 0.01-1.84 pg/mg) plasma protein at baseline to 5.74 pg/mg (IQR, 2.91-9.48 pg/mg) plasma protein after instituting cardiopulmonary bypass, 6.16 pg/mg (IQR, 3.60-9.41 pg/mg) plasma protein after completing circulatory arrest, and 7.64 pg/mg (IQR, 4.63-12.71 pg/mg) plasma protein after weaning from cardiopulmonary bypass (each P value < .0001 vs baseline). Chymase was the only biomarker associated with hypotension during (P = .0255) and after (P = .0221) cardiopulmonary bypass. Increased temperatures at circulatory arrest and low presurgical hemoglobin levels were independent predictors of increased chymase responses. CONCLUSIONS: Mast cell activation occurs in cardiac surgery requiring cardiopulmonary bypass and hypothermic circulatory arrest and is associated with intraoperative hypotension.
Published Version (Please cite this version)10.1016/j.jtcvs.2016.05.063
Publication InfoKertai, Miklos D; Cheruku, Sreekanth; Qi, Wenjing; Li, Yi-Ju; Hughes, G Chad; Mathew, Joseph P; & Karhausen, Jörn A (2017). Mast cell activation and arterial hypotension during proximal aortic repair requiring hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 153(1). pp. 68-76.e2. 10.1016/j.jtcvs.2016.05.063. Retrieved from https://hdl.handle.net/10161/13338.
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Associate Professor of Surgery
Assistant Professor of Anesthesiology
Associate Professor of Anesthesiology
Professor of Biostatistics and Bioinformatics
My research interest is in statistical genetics, primarily in statistical method development and its application for genetic research of human complex diseases. Here is the list of research topics: Statistical genetics: I have involved in the development of several family-based association methods for quantitative traits with or without censoring, and for detecting X-linked genes. With the availability of next generation sequencing data, we have ongoing projects to develop
Jerry Reves, M.D. Distinguished Professor of Cardiac Anesthesiology
Current research interests include:1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.4. The association between genotype and outcome after cardiac surgery.5. Atrial fibrillation
Alphabetical list of authors with Scholars@Duke profiles.