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Mast cell activation and arterial hypotension during proximal aortic repair requiring hypothermic circulatory arrest.

dc.contributor.author Kertai, Miklos D
dc.contributor.author Cheruku, Sreekanth
dc.contributor.author Qi, Wenjing
dc.contributor.author Li, Yi-Ju
dc.contributor.author Hughes, G Chad
dc.contributor.author Mathew, Joseph P
dc.contributor.author Karhausen, Jörn A
dc.coverage.spatial United States
dc.date.accessioned 2017-01-03T15:31:19Z
dc.date.issued 2017-01
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/27697359
dc.identifier S0022-5223(16)31100-X
dc.identifier.uri https://hdl.handle.net/10161/13338
dc.description.abstract 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.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof J Thorac Cardiovasc Surg
dc.relation.isversionof 10.1016/j.jtcvs.2016.05.063
dc.subject blood pressure
dc.subject cardiac surgical procedures
dc.subject inflammation mediators
dc.subject mast cell
dc.title Mast cell activation and arterial hypotension during proximal aortic repair requiring hypothermic circulatory arrest.
dc.type Journal article
duke.contributor.id Kertai, Miklos D|0544354
duke.contributor.id Li, Yi-Ju|0271809
duke.contributor.id Hughes, G Chad|0066100
duke.contributor.id Mathew, Joseph P|0215327
duke.contributor.id Karhausen, Jörn A|0493854
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/27697359
pubs.begin-page 68
pubs.end-page 76.e2
pubs.issue 1
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, Cardiothoracic
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Molecular Physiology Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group School of Medicine
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Cardiovascular and Thoracic Surgery
pubs.publication-status Published
pubs.volume 153
dc.identifier.eissn 1097-685X
duke.contributor.orcid Mathew, Joseph P|0000-0002-3815-4131


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