Endothelial Injury Associated with Cold or Warm Blood Cardioplegia during Coronary Artery Bypass Graft Surgery.

Elmar W Kuhn,Thorsten Wahlers,Oliver J Liakopoulos,Klaus Neef,Yeong-Hoon Choi,Jung-Min Pyun,Thorsten Wittwer,Christof Stamm

doi:10.1155/2015/256905

Abstract

The aim of this investigation was to analyze the impact of intermittent cold blood cardioplegia (ICC) and intermittent warm blood cardioplegia (IWC) on endothelial injury in patients referred to elective on-pump coronary artery bypass graft (CABG) surgery. Patients undergoing CABG procedures were randomized to either ICC or IWC. Myocardial injury was assessed by CK-MB and cardiac troponin T (cTnT). Endothelial injury was quantified by circulating endothelial cells (CECs), von Willebrand factor (vWF), and soluble thrombomodulin (sTM). Perioperative myocardial injury (PMI) and major adverse cardiac events (MACE) were recorded. Demographic data and preoperative risk profile of included patients (ICC: n = 32, IWC: n = 36) were comparable. No deaths, PMI, or MACE were observed. Levels of CK-MB and cTnT did not show intergroup differences. Concentrations of CECs peaked at 6 h postoperatively with significantly higher values for IWC-patients at 1 h (ICC: 10.1 ± 3.9/mL; IWC: 18.4 ± 4.1/mL; P = 0.012) and 6 h (ICC: 19.3 ± 6.2/mL; IWC: 29.2 ± 6.7/mL; P < 0.001). Concentrations of vWF (ICC: 178.4 ± 73.2 U/dL; IWC: 258.2 ± 89.7 U/dL; P < 0.001) and sTM (ICC: 3.2 ± 2.1 ng/mL; IWC: 5.2 ± 2.4 ng/mL; P = 0.011) were significantly elevated in IWC-group at 1 h postoperatively. This study shows that the use of IWC is associated with a higher extent of endothelial injury compared to ICC without differences in clinical endpoints.

Highlights

Cardiopulmonary bypass during cardiac surgical procedures is associated with myocardial and endothelial injury [1,2,3]
The aim of this investigation was to analyze the impact of intermittent cold blood cardioplegia (ICC) and intermittent warm blood cardioplegia (IWC) on endothelial injury in patients referred to elective on-pump coronary artery bypass graft (CABG) surgery
This study shows that the use of IWC is associated with a higher extent of endothelial injury compared to ICC without differences in clinical endpoints

Summary

Introduction

Cardiopulmonary bypass during cardiac surgical procedures is associated with myocardial and endothelial injury [1,2,3]. Myocardial protection in form of intermittent cold (ICC) and intermittent warm blood cardioplegic solutions (IWC) is still under investigation even though clinically introduced decades ago. The use of IWC was demonstrated to be favourable over ICC in low-risk patients referred to coronary artery bypass procedures, whereas ICC was shown to provide superior myocardial protection in high-risk populations requiring prolonged cross clamp times [4, 5]. Since inflammation correlates with the degree of endothelial injury we sought to investigate in the presented study endothelial function in patients undergoing coronary artery bypass graft (CABG) procedures using IWC or ICC. CEC count has never been established for evaluation of IWC and ICC in coronary artery bypass graft (CABG) patients

Methods

Results

Discussion

Conclusion