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Drug May Decrease Complications Following Heart Surgery
While "minimally invasive surgery" helps speed recovery from heart surgery, perhaps the most serious risk in heart surgery comes from a biochemical process known as "complement activation." But in a new study, researchers at the Boston University Medical Center have developed a new method to inhibit complement activation during open heart surgery, thus reducing the risk of postoperative complications which can prolong hospital stays, increase medical expenses, and impair recovery from surgery. According to Harold L. Lazar, MD, associate professor of cardiothoracic surgery at Boston University School of Medicine, infusing a drug called soluble complement receptor type I (sCR1) effectively inhibits complement activation. The study appears in the current issue of the Annals of Thoracic Surgery.
Complement activation -- an inflammatory response triggered by blood circulating through the heart-lung machine -- can lead to complications such as weight gain, decreased pulmonary and cardiac function and irregularities in heartbeat. Pigs (which have cardiac systems similar to those of humans) treated with sCR1 that underwent emergency heart bypass surgery for blocked coronary arteries had better postoperative heart function and significantly smaller amounts of dead heart muscle in the area beyond the blocked arteries than animals that did not receive sCR1.
"If you injure your knee, in a few minutes it becomes swollen and tender," says Lazar. "This inflammatory response is caused by complement activation. It is the body's way of protecting itself. When patients are placed on the heart-lung machine -- even if they are having minimally invasive surgery -- the increased inflammatory response due to complement activation results in this swelling and inflammation throughout the body. Our study shows that sCR1 can block complement activation and decrease its detrimental effects on heart function. Ultimately, this will lead to less postoperative complications, shorter hospital stays, and a faster recovery from surgery."
Lazar is hopeful that these positive experimental results will lead to FDA approval to use sCR1 -- developed by T-Cell Sciences based in Needham, MA -- in clinical trials in patients undergoing open heart surgery. "We may now have a novel approach to eliminating, or at least containing, the problem of complement activation during open heart surgery and the harmful effects of the inflammatory response which accompanies it," he notes.
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