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Alterations of cell-mediated immunity following cardiac operations: clinical implications and open questions
A. Markewitz, W. Lante, A. Franke, K. Marohl, Wolf D. Kuhlmann,
Department of Cardiovascular Surgery, Department of Surgery, Department of Anesthesiology,
Central Military Hospital, Koblenz, Germany
Department of Immunology, Central Institute of the Armed Medical Forces, Koblenz, Germany
Cardiac surgery with cardiopulmonary bypass (CPB) is known to induce an immune response whose nature has been increasingly elucidated during the recent decade. Clinically, patients usually show two to three of the four symptoms, which define the so-called systemic inflammatory response syndrome (SIRS). In addition, all parameters of the innate, nonspecific immune system, e.g., polymorphonuclear cells, elastase, and complement, are activated. This also applies to the proinflammatory mediators interleukin (IL)-1β, -6, and -8, and tumor necrosis factor (TNF)-α. Within the adaptive, specific immune system, a decrease of T lymphocytes and T helper (TH) cells is observed, whereas suppressor/cytotoxic T cells and B cells appear to be nearly unaffected.