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Changes of Vasoactive and Inflammatory Factors, Myocardial Injury Markers During and After Cardiopulmonary Bypass and Off-Pump Surgery FREE TO VIEW

Laszlo Szekely, MD, PhD; Zita Sikos, MD; Beata Soltesz, MD; Matyas Keltai, MD, Prof; Ferenc Horkay, MD
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Gottsegen Gy Hungarian Institute of Cardiology, Section of Cardiac Surgery, Budapest, Hungary


Chest. 2003;124(4_MeetingAbstracts):104S. doi:10.1378/chest.124.4_MeetingAbstracts.104S
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PURPOSE:  There is compelling evidence that off-pump coronary artery bypass operations are associated with reduced inflammatory process and also with less myocardial damages as compared to conventional cardiopulmonary bypass (CPB). Our objectives were to measure the release of myocardial injury markers (troponin-I [Tn-I], creatine kinase [CK] and CK-MB), proinflammatory factor (interleukin-8 [IL-8]), vasoactive mediators (endothelin-1 [ET-1] and adrenomedullin [ADM]) and to compare these data between off- and on-pump cases.

METHODS:  Sixteen patients, undergoing myocardial revascularization were operated off-(n=8) or on-pump (n=8). Blood samples were collected at 5 time points: preoperatively, at the end of surgery, 3, 6, 12 hours after that. Serum levels of Tn-I (ng/ml), CK, CK-MB (U/L), ET-1 (fmol/ml), IL-8 (pg/ml) and ADM (pg/ml) were measured by standard ELISA or RIA technique.

RESULTS:  Based on postoperative ECG, ECHO and enzymes levels, there were no perioperative myocardial infarction occurred. Groups were similar with respect of age, sex, potential risk factors and number of grafts. There were a significant course of elevation in Tn-I, CK and CK-MB levels in the on-pump group, ended up at 12h with 34.2±8.4; 508.6±124.5 and 50.8±10.1 respectively. These parameters were relatively unchanged in the off-pump group during the perioperative period (1.9±0.4; 290.0±75.1 and 16.7±3.3–12h). Both ET-1 (1.1±0.1 vs. 0.9±0.1–12h) and IL-8 (43.0±7.2 vs. 29.8±3.1–12 h) levels were elevated in the on-pump group as compared to off-pumps, however all of them were elevated over the normal range. ADM levels remained significantly unaltered among off-pumps (118.2±15.8–12h). However it was decreased during and shortly after CPB (75.0±11.2–0h) in the on-pump group. Finally, ADM levels followed the course of Tn-I and became elevated (179.7±26.5–12h) in this group.CONCLUSIONS AND CLINICAL IMPLICATIONS: Based on our preliminary data, it can be concluded that coronary bypass grafting without using CPB offers better myocardial protection, lower inflammatory reaction, less endothelial damage even for uncomplicated cases.

DISCLOSURE:  L. Szekely, None.

Tuesday, October 28, 2003

12:30 PM - 2:00 PM




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