Importantly , the activation of the immune system and subsequent inflammatory response is simultaneously countered by a compensatory anti-inflammatory response , which serves to suppress the inflammatory response to augment return to immunological homeostasis. There has been increasing understanding that extremes of either an unbridled inflammatory response or persistent suppression of immune responses after cardiac surgery are associated with adverse outcomes. The systemic inflammatory response is strongly implicated in cardiac, renal, pulmonary, hematologic, and neurological dysfunction in the postoperative period.
Greathouse describes extensively the approaches to reduce inflammation and improve immune function post Cardiopulmonary Bypass:
Pump mechanisms: Mini extracorporeal circuits, biocompatible coating, modified ultrafiltration, leucocyte reducing filters
Pharmacologic mechanisms: Steroids, Serine Protease Inhibitors, other
The most promising interventions are multi-modal ones (e.g. pharmacologic combined with mechanical strategies), those targeting multiple inflammatory pathways.