Relationship Between Granulocyte Elastase and C3a Under Protamine Dosing in On-Pump Cardiac Surgery

Objective: The complement cascade and granulocytes are activated in on-pump cardiac surgery. If activation of complement directly regulates granulocytes, granulocyte elastase (GEL) should increase significantly after protamine administration. We examined the effect of protamine on granulocytes by protamine administration and observation of the effect on GEL and C3a.

Methods: Thirty patients who underwent coronary artery bypass grafting were randomly assigned to two groups. In 15 patients, protamine was administered 5min after the termination of cardiopulmonary bypass, and was administered 35min after cardiopulmonary bypass in the other 15 patients. All patients were perfused with heparin-coated circuits and received 300IU/kg heparin and 3mg/kg protamine. GEL and C3a concentrations were measured at 7 time points.

Results: GEL concentrations increased significantly just before aortic declamping and did not increase significantly after protamine administration. C3a concentrations, however, did not increase during cardiopulmonary bypass and did increase significantly after protamine administration.

Conclusions: This study indicates that GEL does not increase after protamine administration and that complement concentration does not directly affect GEL release.