Influence of hepatic mitochondrial redox state on complement biosynthesis and activation during and after cardiopulmonary bypass operations

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Abstract
We have proposed the hazardous phenomena associated with cardiopulmonarybypass (CPB) are due to metabolic derangement by hepatic mitochondrialdysfunction during and after CPB. On the contrary, complement activationand consumption during CPB is reported to be related to the morbidityassociated with cardiac surgery. To determine the significance of thehepatic mitochondrial function on the morbidity of cardiac surgery, wemeasured the serum levels of complements (C3 and C4), activated complements(C3a and C4a), and the arterial ketone body ratio (AKBR), which reflectsthe hepatic mitochondrial redox state, in 30 patients undergoing CPB. TheAKBR, which was at a normal level preoperatively, dropped to a criticallevel after the initiation of CPB and remained at a low level during theCPB, returning to the preoperative level on the second postoperativemorning in a time dependent fashion. The patients group were assigned totwo groups according to their AKBR on the first postoperative morning.Group I consisted of patients whose AKBR had recovered to above 0.7 on thefirst postoperative morning (n = 16). Group II consisted of the rest of thepatients (n = 14). The serum complement concentration had considerablydecreased by the end of bypass, but recovered in a time- dependent fashionafter CPB. The group I patients (C3: 71% of its preoperative value, C4: 85%of its preoperative value) recovered their complements more quickly thanthe group II patients (C3: 56% of its preoperative value, C4: 54% of itspreoperative value). However, the serum C3a and C4a concentrationsincreased by the end of bypass (C3a: 806% of its preoperative value, C4a:341% of its preoperative value). The activated complements weresignificantly higher in the group II patients (C3a: 124% of itspreoperative value, C4a: 236% of its preoperative value) than in the groupI patients (C3a: 75% of its preoperative value, C4a: 113% of itspreoperative value) on the first postoperative morning. It is suggestedthat hepatic mitochondrial function is related to recovering thecomplements and to reducing the activated complements after CPB.

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