Association of β1 and β2-adrenoceptor Polymorphisms With the Demand of Inotropic Catecholamine Support Following Coronary Artery Bypass Grafting in Iranian Population

2020 ◽  
Author(s):  
Gohar Eslami ◽  
Rahman Ghafari ◽  
Valiollah Habibi ◽  
Akbar Hedayatizadeh-Omran ◽  
Mahmood Moosazadeh ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Iranian Population ◽  
Cardiac Response ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Direct Dna Sequencing

Abstract Background: Hemodynamic instability is a common complication in the first hours following cardiac surgery and inotropic catecholamine support is an acceptable treatment strategy for its management. β1 and β2-adrenoceptors (β1 and β2 AR) are mediated the positive inotropic and chronotropic responses of the heart to catecholamines. Previous evidence has suggested an association between β1 and β2AR polymorphisms and cardiac response and change in receptor signaling. The aim of this study was evaluating the relationship between β1 and β2AR polymorphisms with demand of catecholamine inotropic support among coronary artery bypass grafting (CABG) patients.Methods: One hundred ninety-eight consecutive patients who underwent CABG with cardiopulmonary bypass were included in this study. We assessed hemodynamic parameters, dose and duration of inotropic support according to β1 and β2AR genotypes in post-operative period. DNA genotyping were assessed through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and PCR genotyping results were confirmed by direct DNA sequencing. Results: The our results indicated that patients carrying one or two alleles of the Arg389-β1AR variant required significantly shorter inotropic support time compared with patients homozygous for the Gly389-β1AR (p=0.003). Finally, neither β1AR polymorphisms nor Arg16Gly-β2AR polymorphism are associated with catecholamines-induced hemodynamic effects.Conclusion: These findings suggest that genetic variability in the β1 and β2AR polymorphisms may not be a major determinant of cardiac responses to catecholamine treatment in Iranian population. However, larger scale studies with different ethnicities are needed for confirmation.

scholarly journals Comparison of Custodiol® and modified St. Thomas cardioplegia for myocardial protection in coronary artery bypass grafting

2020 ◽  
Vol 77 (11) ◽  
pp. 1126-1134
Author(s):  
Dragan Cvetkovic ◽  
Mladen Kocica ◽  
Ljiljana Soskic ◽  
Filip Vucicevic ◽  
Olga Petrovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Bypass Grafting ◽  
Cardioplegic Solution ◽  
Artery Bypass Grafting ◽  
Spontaneous Rhythm

Background/Aim. Custodiol? is a hyperpolarizing cardioplegic solution which has been used in our national cardiac surgical practice exclusively for the heart transplant surgery. Owing to its numerous advantages over the standard depolarizing solutions, Custodiol? became cardioplegic solution of choice for all other cardiac surgical procedures in many cardio-surgical centers. This study evaluated myocardial protection by Custodiol? compared to modified St. Thomas cardioplegic solution in coronary artery bypass surgery. Methods. In a prospective four-month study, 110 consecutive adult patients who underwent primary isolated elective on-pump coronary artery bypass grafting (CABG) were randomized into the Custodiol? group (n = 54) and the St. Thomas groupa (n = 50), based on the type of administered cardioplegia; six patients were excluded. Cardiac protection was achieved as antegrade cold crystalloid cardioplegia by one of the solutions. Myocardial preservation was assessed through following outcomes: spontaneous rhythm restoration post cross-clamp, and postpoperative cardiac specific enzymes level, ejection fraction (EF) change, inotropic support, myocardial infarction (MI), atrial fibrillation (AF), and death. Results. Preoperative and intraoperative characteristics of patients in both groups were similar except for a considerably longer cross-clamp time in the Custodiol? group (49.1 ? 19.0 vs. 41.0 ? 12.9 minutes; p = 0.022). The Custodiol? group exhibited a higher rate of return to spontaneous rhythm compared to the St. Thomas group (31.5% vs. 20.0%, respectively; p = 0.267), lower rates of AF (20.4% vs. 28%, respectively; p = 0.496), MI (1.8% vs. 10.0%, respectively; p = 0.075) and inotropic support (9.0% vs. 12.0%, respectively; p = 0.651), albeit not statistically significant. There was an insignificant difference in peak value of troponin I between the Custodiol? and Thee St. Thomas group (5.0 ? 3.92 ?g/L vs. 4.5 ? 3.39 ?g/L, respectively; p = 0.755) and creatine kinase-MB (26.9 ? 15.4 ?g/L vs. 28.5 ? 24.2 ?g/L, respectively; p = 0.646) 6 hours post-surgery. EF reduction was comparable (0.81% vs. 1.26%; p = 0.891). There were no deaths in both groups. Conclusions. Custodiol? and modified St.Thomas cardioplegic solution have comparable cardioprotective effects in CABG surgery. The trends of less frequent MI, AF and ino-tropic support, despite the longer cross-clamp time in the Custodiol? group may suggest that its benefits could be ascertained in a larger study.

Preoperative and Intraoperative Predictors of Inotropic Support and Long-Term Outcome in Patients Having Coronary Artery Bypass Grafting

1991 ◽  
Vol 72 (6) ◽  
pp. 729???736 ◽  
Author(s):  
Roger L. Royster ◽  
John F. Butterworth ◽  
Donald S. Prough ◽  
William E. Johnston ◽  
Julia L. Thomas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Bypass Grafting ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Artery Bypass Grafting

scholarly journals The Predictive Value of Preoperative Serum NTproBNP Levels for the Need for Inotropic Support in the Postoperative Period in Patients Undergoing Coronary Artery Bypass Grafting

2017 ◽  
Vol 9 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Ahmet Öztekin ◽  
Mehmet Erdem Memetoðlu ◽  
Rasim Kutlu ◽  
Ali Ihsan Tekin ◽  
Ozan Erbasan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Preoperative Serum ◽  
Group 2

Background: High preoperative BNP levels can be a marker of higher risk for coronary artery bypass grafting. We investigated the predictive value of serum NT-proBNP levels undergoing coronary artery bypass grafting for the need for inotropic support. Methods: In this prospective study, preoperative serum NT-proBNP levels were obtained in 51 patients [80.4% (n=42) were males and 19.6% (n=9) were females] undergoing isolated coronary artery bypass grafting. The study patients were divided into three groups depending on NT-proBNP levels as low NT-proBNP (<100 pg/ml, Group-1, 29.4%, n=15) group, moderately high NT-proBNP (NT-proBNP <500 pg/mL and >100 pg/mL, Group-2, 29.4%, n=15) group, and high NT-proBNP (>500 pg/mL, Group-3, 41.2%, n=21) group.Results: At postoperative day 0, the mean adrenalin, dopamine, dobutamine, and noradrenalin consumptions were 0.1±0.7 microgram/kg/min, 0.08±0.56 microgram/kg/min, 2.1±3.01 microgram/ kilogram/min, and 1.35±3.45 microgram/kg/min, respectively. There were no statistically significant differences between the groups in terms of the use of adrenalin (p=0.50, p>0.05), dopamine (p=0.31 p>0.05), dobutamine (p=0.59 p>0.05), and noradrenalin (p=0.24 p>0.05) at postoperative day 0. The doses of inotropic agents used at postoperative days 1 and 2 did not show significant differences between the groups for the three inotropic agents.Conclusion: Preoperative serum NT-proBNP levels in patients undergoing coronary artery bypass grafting are not associated with the need for inotropic support in the postoperative period.Cardiovasc. j. 2017; 9(2): 90-96

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