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1.
Eur J Cardiothorac Surg ; 39(5): 675-83, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20884221

RESUMO

OBJECTIVE: To assess the safety and efficacy of on-pump beating heart coronary surgery on organ function, and early and late health outcome as compared with conventional technique. METHODS: A total of 81 patients were randomised to (1) coronary surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) (on-pump with CA, n=41) or to (2) CPB without CA (on-pump without CA, n=40). Primary outcomes included serial measurement of interleukins (IL-6, IL-8 and IL-10) for inflammation, troponin I for myocardial injury, protein S100 for cerebral injury and creatinine clearance (CrCl) and urinary N-acetyl-ß-d-glucosaminidase (NAG) for renal injury. In-hospital health outcome and 5-year event-free survival were secondary outcomes. RESULTS: Baseline and intra-operative characteristics were similar between groups. A marked release of ILs was observed in both groups, but no significant differences between the groups were found (IL-6 +9%, 95% confidence interval (CI) -15% to +39%, p=0.49; IL-8 +4%, 95% CI -34% to +63%, p=0.86; IL-10 -0.1%, 95% CI -19% to +21%, p=0.93). Troponin I rose in both groups and was on average 34% higher in the on-pump without CA group but this did not reach statistical significance (95% CI -0.4% to +87%, p=0.08). S100 protein was higher in the on-pump without CA group at 12h (p=0.04) but did not differ at other times (p=0.16). The level of CrCl was higher 1h in the on-pump without CA group (+23%, 95% CI +1% to +50%, p=0.04), but not thereafter. NAG release was similar in both groups (+1% 95% CI -23% to +33%, p=0.91). Early and 5-year health outcomes were similar. CONCLUSIONS: On-pump without CA coronary surgery does not provide any obvious advantage when compared with the conventional technique of on-pump with CA in elective patients. Both techniques provide a comparable degree of inflammatory activation, myocardial, cerebral and renal injury with similar 5-year event-free survival.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Acetilglucosaminidase/urina , Idoso , Biomarcadores/sangue , Encefalopatias/etiologia , Cardiomiopatias/etiologia , Ponte de Artéria Coronária/métodos , Creatinina/urina , Feminino , Seguimentos , Humanos , Inflamação/etiologia , Mediadores da Inflamação/sangue , Interleucinas/sangue , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Proteínas S100/sangue , Resultado do Tratamento , Troponina I/sangue
2.
J Thorac Cardiovasc Surg ; 138(1): 206-14, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19577081

RESUMO

OBJECTIVES: This study investigates the effects of controlled reoxygenation cardiopulmonary bypass on oxidative stress, inflammatory response, and organ function in children undergoing repair of cyanotic congenital heart defects. METHODS: Sixty-seven cyanotic patients (median age 15 months, interquartile range 6-49 months) undergoing corrective cardiac surgery were randomized to receive either controlled normoxic (50-0 mm Hg; n = 35) or hyperoxic (150-180 mm Hg; n = 32) cardiopulmonary bypass. Troponin I and 8-isoprostane, C3a, interleukins 6, 8, and 10, cortisol, protein S100, and alpha-glutamate transferase were measured preoperatively and 10 and 30 minutes after starting bypass, on removal of the aortic crossclamp, and 12 and 24 hours thereafter. RESULTS: Overall, troponin I and 8-isoprostane levels were lower in the controlled normoxic group (-29%, 95% CI -48% to -3%, P = .03, and -26%, 95% CI -44% to -2%, P = .03, respectively). Protein S100 release was also lower in the normoxic group 10 minutes after starting bypass (-26%, 95% CI -40% to -9%, P = .005) and 10 minutes after aortic crossclamp removal (-23%, 95% CI -38% to -3%, P = .02, respectively), but similar at other time points in the two groups (P >or= .17). The alpha-glutamate transferase release was significantly lower in the normoxic group 10 minutes after aortic crossclamp removal (-28%, 95% CI -44% to -9%, P = .006, respectively) but was similar at other times (P >or= .11). Release of C3a, interleukins 6, 8, and 10, and cortisol was similar in the two groups throughout (P >or= .15). CONCLUSION: Controlled reoxygenation on starting cardiopulmonary bypass is associated with reduced myocardial damage, oxidative stress, and cerebral and hepatic injury compared with hyperoxic bypass and similar whole body inflammatory and stress response in cyanotic children undergoing open cardiac surgery.


Assuntos
Ponte Cardiopulmonar/métodos , Cardiopatias Congênitas/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Pré-Escolar , Complemento C3a/análise , Cianose , Dinoprosta/análogos & derivados , Dinoprosta/sangue , Feminino , Glutationa Transferase , Cardiopatias Congênitas/sangue , Humanos , Hidrocortisona/sangue , Lactente , Inflamação/sangue , Interleucinas/sangue , Masculino , Estresse Oxidativo , Oxigênio/sangue , Proteínas S100/sangue , Troponina I/sangue
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