| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1997;63:68-73
© 1997 The Society of Thoracic Surgeons
Cardiothoracic Department, Killingbeck Hospital, Leeds, United Kingdom
Accepted for publication July 19, 1996.
Background. Cytokines are implicated in the pathogenesis of the "whole-body inflammatory response" that may complicate the period after cardiopulmonary bypass (CPB). Low-dose aprotinin in the pump during CPB has been shown to improve postoperative hemostasis and platelet preservation. We tested the hypothesis that low-dose aprotinin influences the inflammatory reaction (in terms of cytokine release) after CPB.
Methods. In a prospective, randomized study, 38 patients undergoing elective coronary artery bypass grafting were investigated. Nineteen patients received low-dose aprotinin (2 x 106 KIU [280 mg] in the pump), and a control group of 19 did not. Complement activation, cytokine production, leukocyte elastase release, D-dimer level, full blood count, postoperative blood loss, and transfusion requirements were analyzed before, during, and after CPB.
Results. Interleukin-1ß was not detected in either group, whereas traces of tumor necrosis factor-
were infrequently observed. Plasma elastase, interleukin-6, interleukin-8, and neutrophil count increased (p < 0.001) during and after CPB compared with the baseline levels, reaching a peak at 2 hours after protamine administration in both groups before returning toward baseline at 24 hours. Proinflammatory cytokine markers did not differ significantly (p > 0.1) between the groups throughout the study period. The C5b-9 level increased (p < 0.001) in both groups perioperatively, reaching its peak 15 minutes after protamine. Twenty-four–hour postoperative blood loss was significantly (p < 0.001) reduced in the aprotinin group in association with markedly reduced D-dimer levels (p < 0.001). Patients in the aprotinin group also received significantly less banked blood postoperatively than the control group (p < 0.01).
Conclusions. Low-dose aprotinin fails to modify proinflammatory cytokine release, yet confers hemostatic improvement through reduced fibrinolysis in patients undergoing routine coronary artery bypass grafting.
This article has been cited by other articles:
|
|
 |
|
  G. N. Vaccarino, J. Thierer, M. Albertal, M. Vrancic, F. Piccinini, M. Benzadon, H. Raich, and D. O. Navia Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 309 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Goebel, M. Siepe, A. Mecklenburg, T. Doenst, F. Beyersdorf, T. Loop, and C. Schlensak Reduced pulmonary inflammatory response during cardiopulmonary bypass: effects of combined pulmonary perfusion and carbon monoxide inhalation Eur. J. Cardiothorac. Surg., December 1, 2008; 34(6): 1165 - 1172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Hammon Extracorporeal Circulation: The Response of Humoral and Cellular Elements of Blood to Extracorporeal Circulation Card. Surg. Adult, January 1, 2008; 3(2008): 370 - 389. [Full Text]
|
|
|
|
 |
|
 E. I. Kapetanakis, D. A. Medlam, K. R. Petro, E. Haile, P. C. Hill, M. K.C. Dullum, A. S. Bafi, S. W. Boyce, and P. J. Corso Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery: Are We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae? Circulation, April 4, 2006; 113(13): 1667 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Fergusson, K. C. Glass, B. Hutton, and S. Shapiro Randomized controlled trials of aprotinin in cardiac surgery: could clinical equipoise have stopped the bleeding? Clinical Trials, June 1, 2005; 2(3): 218 - 232. [Abstract] [PDF]
|
|
|
|
 |
|
 R. de Vroege, W. van Oeveren, J. van Klarenbosch, W. Stooker, M. A. J. M. Huybregts, C. E. Hack, L. van Barneveld, L. Eijsman, and C. R. H. Wildevuur The Impact of Heparin-Coated Cardiopulmonary Bypass Circuits on Pulmonary Function and the Release of Inflammatory Mediators Anesth. Analg., June 1, 2004; 98(6): 1586 - 1594. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Mirsadraee, A. Fraser, M. A Kerr, T. E James, and C. van Doorn Inflammatory response in an immunosuppressed patient with Wegener's granulomatosis Perfusion, March 1, 2004; 19(2): 127 - 131. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. Yoshimura, Y. Hiramatsu, Y. Sato, S. Homma, Y. Enomoto, T. Jikuya, and Y. Sakakibara ONO-6818, a novel, potent neutrophil elastase inhibitor, reduces inflammatory mediators during simulated extracorporeal circulation Ann. Thorac. Surg., October 1, 2003; 76(4): 1234 - 1239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Mossinger, W. Dietrich, S. L. Braun, M. Jochum, H. Meisner, and J. A. Richter High-dose aprotinin reduces activation of hemostasis, allogeneic blood requirement, and duration of postoperative ventilation in pediatric cardiac surgery Ann. Thorac. Surg., February 1, 2003; 75(2): 430 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Frumento, C. M.N. O'Malley, and E. Bennett-Guerrero Stroke after cardiac surgery: a retrospective analysis of the effect of aprotinin dosing regimens Ann. Thorac. Surg., February 1, 2003; 75(2): 479 - 483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Schmartz, Y. Tabardel, J.-C. Preiser, L. Barvais, A. d'Hollander, J. Duchateau, and J.-L. Vincent Does aprotinin influence the inflammatory response to cardiopulmonary bypass in patients? J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 184 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Menasche and L. H. Edmunds Jr. Extracorporeal Circulation: The Inflammatory Response Card. Surg. Adult, January 1, 2003; 2(2003): 349 - 360. [Full Text]
|
|
|
|
|
|
L. Englberger, B. Kipfer, P. A. Berdat, U. E. Nydegger, and T. P. Carrel Aprotinin in coronary operation with cardiopulmonary bypass: does "low-dose" aprotinin inhibit the inflammatory response? Ann. Thorac. Surg., June 1, 2002; 73(6): 1897 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Diegeler, N. Spyrantis, M. Matin, V. Falk, R. Hambrecht, R. Autschbach, F. W. Mohr, and G. Schuler The revival of surgical treatment for isolated proximal high grade LAD lesions by minimally invasive coronary artery bypass grafting Eur. J. Cardiothorac. Surg., May 1, 2000; 17(5): 501 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Siebert, J. Rogowski, D. Jagielak, L. Anisimowicz, R. Lango, and M. Narkiewicz Atrial fibrillation after coronary artery bypass grafting without cardiopulmonary bypass Eur. J. Cardiothorac. Surg., May 1, 2000; 17(5): 520 - 523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-O. Defraigne, J. Pincemail, R. Larbuisson, F. Blaffart, and R. Limet Cytokine release and neutrophil activation are not prevented by heparin-coated circuits and aprotinin administration Ann. Thorac. Surg., April 1, 2000; 69(4): 1084 - 1091. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Forestier, S. Belisle, D. Robitaille, R. Martineau, L. P. Perrault, and J.-F. Hardy Low-dose aprotinin is ineffective to treat excessive bleeding after cardiopulmonary bypass Ann. Thorac. Surg., February 1, 2000; 69(2): 452 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Hayashida, H. Tomoeda, T. Oda, E. Tayama, S. Chihara, T. Kawara, and S. Aoyagi Inhibitory effect of milrinone on cytokine production after cardiopulmonary bypass Ann. Thorac. Surg., November 1, 1999; 68(5): 1661 - 1667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Diegeler, M. Matin, V. Falk, C. Binner, T. Walther, R. Autschbach, and F.-W. Mohr Quality assessment in minimally invasive coronary artery bypass grafting Eur. J. Cardiothorac. Surg., November 1, 1999; 16(suppl_2): S67 - S72. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Diegeler, M. Matin, S. Kayser, Ch. Binner, R. Autschbach, R. Battellini, H. Krankenberg, and F.W. Mohr Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach Eur. J. Cardiothorac. Surg., May 1, 1999; 15(5): 680 - 684. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Miyashita, Y. Hayashi, Y. Ohnishi, and M. Kuro Retrospective analysis of effect of low-dose aprotinin priming on allogeneic blood transfusion in repeated cardiac operations Perfusion, May 1, 1999; 14(3): 189 - 194. [Abstract] [PDF]
|
|
|
|
|
|
C. Baufreton, L. Intrator, P. G.M. Jansen, H. te Velthuis, P. Le Besnerais, A. Vonk, J.-P. Farcet, C. R.H. Wildevuur, and D. Y. Loisance Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps Ann. Thorac. Surg., April 1, 1999; 67(4): 972 - 977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Baufreton, M. Moczar, L. Intrator, P. G. Jansen, H. te Velthuis, P. Le Besnerais, J. P. Farcet, C. R. Wildevuur, and D. Y Loisance Inflammatory response to cardiopulmonary bypass using two different types of heparin-coated extracorporeal circuits Perfusion, December 1, 1998; 13(6): 419 - 427. [Abstract] [PDF]
|
|
|
|
|
|
C. Baufreton, M. Kirsch, and D. Y. Loisance Measures to control blood activation during assisted circulation Ann. Thorac. Surg., November 1, 1998; 66(5): 1837 - 1844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hultman Anaesthesia and monitoring for minimally invasive cardiac surgery with special reference to minimally invasive direct coronary artery bypass surgery Perfusion, July 1, 1998; 13(4): 259 - 264. [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
