2024, Number 1
Cir Card Mex 2024; 9 (1)
Regulatory T cells in the "inflammatory balance" as a response to extracorporeal circulation in cardiac surgery. A narrative review
Rodríguez-Morales, Maximiliano; Díaz-Quiroz, Guillermo; Aceves-Chimal, José L; Flores-Calderón, Octavio; García-Ortegón, María S; Jaime-Uribe, Andres; Morales-Cruz, Margarito; Sánchez-Godínez, Mario F; Matus-Yarce, Jesús C; Viscarra-León, Jairo F; Rodríguez-Delgado, Jorge E; Corona-Chávez, César E; Polanco-Lozada, Juan RD; Bustos-Alcazar, Ricardo A; Xochitemol-Herrera, Hugo; Mata-Ortega, Juan A; Serrano-González, Sheyla P; Romero-Pérez, David A; Torres-Álvarez, María G; Sánchez-Becerril, Iván; Cruz-Hernández, Saúl; Morán-Chaidez, Elisa
ABSTRACT
Extracorporeal circulation (ECC) offers the benefit of maintaining a bloodless and still surgical field, providing a suitable surgical scenario for the performance of the surgical procedure. It is an essential procedure in virtually all heart surgeries, aiming to temporarily replace the function of the cardiopulmonary system, thus maintaining blood perfusion to organs and body tissues. Unfortunately, the use of this procedure triggers an inflammatory cascade, with endothelial dysfunction being the main triggering mechanism. This damage is a result of the contact between blood components with synthetic plastic surfaces, activating an intense inflammatory response, impacting the postoperative outcomes of patients undergoing this procedure. Regulatory T cells (Tregs) are a subtype of T lymphocytes that play a role in modulating the inflammatory response, specially by activation of a transcription factor called FOXP3. In this revision was identified that the understanding of Treg lymphocytes T and ECC interaction will improve an opportunity to comprehend the physiopathology of development and activation of inflammatory process into cardiac surgery, although ECC has generated an impact on cardiac surgery, also has a price to pay associated to inflammatory phenomenon with negative effect on postsurgical evolution in patients that underwent to cardiac surgery and the recognition of the lymphocytes TregFoxP3 regulatory capacity offer to develop future strategies that promote activation and it´s preservation during ECC through immunomodulatory drugs, such as corticosteroids and adrenergic receptor agonists will to help improve the outcomes of heart surgery.