ENDOTOXIN RELATED EARLY NEUTROPHIL ACTIVATION IS ASSOCIATED WITH OUTCOME AFTER THORACOABDOMINAL AORTIC-ANEURYSM REPAIR

Background Thoracoabdominal aortic aneurysm (TAAA) repair is associate d with high mortality rates, especially in patients who develop postop erative renal and pulmonary impairment. Organ damage during TAAA repai r may be mediated by activated polymorphonuclear neutrophils (PMNs) du ring 3 systemic inflammatory response. The association between intraop erative neutrophil activation and postoperative outcome was studied af ter TAAA surgery. Methods Perioperative PMN activation (surface CD11b expression by flow cytometry), plasma endotoxin, plasma endotoxin core antibody, tumour necrosis factor (TNF), and interleukin 1 (IL-1) leve ls were measured in 21 patients undergoing TAAA repair. Results Intrao perative PMN CD 11b expression was significantly greater in the 11 pat ients who developed pulmonary and renal complications than in those wh o made an uneventful recovery (P = 0.0009). In addition, CD11b express ion during visceral reperfusion was preceded by a rise in plasma endot oxin level and a fall in antibody level (reflecting binding by absorbe d endotoxin) which was significantly greater in patients who developed complications (P = 0.031 and P = 0.001 respectively). Plasma endotoxi n level correlated with CD11b expression (r = 0.828, P = 0.001). There were no significant differences in intraoperative plasma levels of TN F and IL-l, or aortic crossclamp times and blood transfusion volumes b etween the complicated and uncomplicated repairs. Conclusion Intraoper ative neutrophil activation is a marker for the development of postope rative complications after TAAA reconstruction and is associated with endotoxin absorption.