scholarly journals Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery

Cells ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 2717
Author(s):  
Maks Mihalj ◽  
Paul Philipp Heinisch ◽  
Markus Huber ◽  
Joerg Schefold ◽  
Alexander Hartmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Protective Effect ◽  
Clinical Outcomes ◽  
Plasma Levels ◽  
Plasma Lipid ◽  
Lipid Levels ◽  
Lipid Status ◽  
Postoperative Stroke

Patients undergoing cardiac surgery are at increased cardiovascular risk, which includes altered lipid status. However, data on the effect of cardiac surgery and cardiopulmonary bypass (CPB) on plasma levels of key lipids are scarce. We investigated potential effects of CPB on plasma lipid levels and associations with early postoperative clinical outcomes. This is a prospective bio-bank study of patients undergoing elective cardiac surgery at our center January to December 2019. The follow-up period was 1 year after surgery. Blood sampling was performed before induction of general anesthesia, upon weaning from cardiopulmonary bypass (CPB), and on the first day after surgery. Clinical end points included the incidence of postoperative stroke, myocardial infarction, and death of any cause at 30 days after surgery as well as 1-year all-cause mortality. A total of 192 cardiac surgery patients (75% male, median age 67.0 years (interquartile range 60.0–73.0), median BMI 26.1 kg/m2 (23.7–30.4)) were included. A significant intraoperative decrease in plasma levels compared with preoperative levels (all p < 0.0001) was observed for total cholesterol (TC) (Cliff’s delta d: 0.75 (0.68–0.82; 95% CI)), LDL-Cholesterol (LDL-C) (d: 0.66 (0.57–0.73)) and HDL-Cholesterol (HDL-C) (d: 0.72 (0.64–0.79)). At 24h after surgery, the plasma levels of LDL-C (d: 0.73 (0.650.79)) and TC (d: 0.77 (0.69–0.82)) continued to decrease compared to preoperative levels, while the plasma levels of HDL-C (d: 0.46 (0.36–0.55)) and TG (d: 0.40 (0.29–0.50)) rebounded, but all remained below the preoperative levels (p < 0.001). Mortality at 30 days was 1.0% (N = 2/192), and 1-year mortality was 3.8% (N= 7/186). Postoperative myocardial infarction occurred in 3.1% of patients (N = 6/192) and postoperative stroke in 5.8% (N = 11/190). Adjusting for age, sex, BMI, and statin therapy, we noted a protective effect of postoperative occurrence of stroke for pre-to-post-operative changes in TC (adjusted odds ratio (OR) 0.29 (0.07–0.90), p = 0.047), in LDL-C (aOR 0.19 (0.03–0.88), p = 0.045), and in HDL-C (aOR 0.01 (0.00–0.78), p = 0.039). No associations were observed between lipid levels and 1-year mortality. In conclusion, cardiac surgery induces a significant sudden drop in levels of key plasma lipids. This effect was pronounced during the operation, and levels remained significantly lowered at 24 h after surgery. The intraoperative drops in LDL-C, TC, and HDL-C were associated with a protective effect against occurrence of postoperative stroke in adjusted models. We demonstrate that the changes in key plasma lipid levels during surgery are strongly correlated, which makes attributing the impact of each lipid to the clinical end points, such as postoperative stroke, a challenging task. Large-scale analyses should investigate additional clinical outcome measures.

Use of Aprotinin in the Control of Bleeding During Cardiopulmonary Bypass Surgery: Current Status

1998 ◽  
Vol 4 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Roque Pifarrè
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Whole Body ◽  
Current Status ◽  
Blood Transfusions ◽  
Donor Blood ◽  
Excessive Bleeding

Excessive bleeding is one of the major complica tions of cardiac surgery with cardiopulmonary bypass (CPB). This complication is related to the operation and the defects in hemostasis induced by extracorporeal circulation. The system atic effects of CPB are called whole body inflammatory reac tion. Heparin, platelet dysfunctions, and fibrinolysis are the major causes of bleeding problems associated with CPB. Dif ferent pharmacological approaches have been used to reduce bleeding and the need for blood transfusions in patients under going cardiac surgery. The most effective is aprotinin, a serum protease inhibitor that is an antifibrinolytic with a platelet- preserving action. It inhibits the activation of the intrinsic co agulation system. Aprotinin therapy effectively reduces blood loss and donor blood requirements. According to most reports, it does not increase the risk of acute myocardial infarction, renal dysfunction, and mortality.

scholarly journals A Weak Response to Endoplasmic Reticulum Stress Is Associated With Postoperative Organ Failure in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

2021 ◽  
Vol 7 ◽  
Author(s):  
Thomas Clavier ◽  
Zoé Demailly ◽  
Xavier Semaille ◽  
Caroline Thill ◽  
Jean Selim ◽  
...  
Keyword(s):  
Endoplasmic Reticulum ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Endoplasmic Reticulum Stress ◽  
Organ Failure ◽  
Plasma Levels ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Total Blood ◽  
Expression Of Genes

Introduction: Endoplasmic reticulum stress (ERS) is involved in inflammatory organ failure. Our objective was to describe ERS, its unfolded protein response (UPR) expression/kinetics during cardiac surgery with cardiopulmonary bypass (CPB) and its association with postoperative organ failure (OF).Methods: Prospective study conducted on patients undergoing cardiac surgery with CPB. Blood samples were taken before (Pre-CPB), 2 h (H2-CPB) and 24 h (H24-CPB) after CPB. Plasma levels of 78 kDa Glucose- Regulated Protein (GRP78, final effector of UPR) were evaluated by ELISA. The expression of genes coding for key elements of UPR (ATF6, ATF4, sXBP1, CHOP) was evaluated by quantitative PCR performed on total blood. OF was defined as invasive mechanical ventilation and/or acute kidney injury and/or hemodynamic failure requiring catecholamines.Results: We included 46 patients, GRP78 was decreased at H2-CPB [1,328 (878–1,730) ng/ml vs. 2,348 (1,655–3,730) ng/ml Pre-CPB; p &lt; 0.001] but returned to basal levels at H24-CPB [2,068 (1,436–3,005) ng/ml]. The genes involved in UPR had increased expression at H2 and H24. GRP78 plasma levels in patients with OF at H24-CPB (n = 10) remained below Pre-CPB levels [−27.6 (−51.5; −24.2)%] compared to patients without OF (n = 36) in whom GRP78 levels returned to basal levels [0.6 (−28.1; 26.6)%; p &lt; 0.01]. H24-CPB ATF6 and CHOP expressions were lower in patients with OF than in patients without OF [2.3 (1.3–3.1) vs. 3.0 (2.7–3.7), p &lt; 0.05 and 1.3 (0.9–2.0) vs. 2.2 (1.7–2.9), p &lt; 0.05, respectively].Conclusions: Low relative levels of GRP78 and weak UPR gene expression appeared associated with postoperative OF. Further studies are needed to understand ERS implication during acute organ failure in humans.

scholarly journals Effects of Perioperative Transcutaneous Electrical Acupoint Stimulation on Monocytic HLA-DR Expression in Patients undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass: Study Protocol for a Double-blind Randomized Controlled Trial

2019 ◽  
Author(s):  
Wen-ting Chen ◽  
Jin-feng Wei ◽  
Lan Wang ◽  
Deng-wen Zhang ◽  
Wei Tang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Infectious Complications ◽  
Invasive Technique ◽  
Effective Prevention ◽  
Hla Dr ◽  
Acupoint Stimulation

Abstract Abstract Background: Cardiac surgery involving cardiopulmonary bypass (CPB) is known to be associated with a transient postoperative immunosuppression. When severe and persistent, this immune dysfunction predisposes patients to infectious complications, which contributes to a prolonged stay in the intensive care unit (ICU), even mortality. The effective prevention and treatment methods are still lacking. Recent studies revealed that acupuncture related techniques, such as electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), are able to produce effective cardioprotection and immunomodulation in adult and pediatric patients undergoing cardiac surgery with CPB, which leads to enhanced recovery. However, whether perioperative application of TEAS, a non-invasive technique, is able to improve immunosuppression of the patients with post cardiosurgical conditions is unknown. Thus, as a preliminary study, the main objective is to evaluate the effects of TEAS on the postoperative expression of monocytic human leukocyte antigen (-D related) (mHLA-DR), a standardized “global” biomarker of injury or sepsis-associated immunosuppression, in patients receiving on-pump CABG. Methods: This clinical study was a single-center clinical trial. The 88 patients scheduled to receive CABG under CPB were randomized into 2 groups: the group of TEAS, and the group of transcutaneous acupoint pseudo - electric stimulation (Sham TEAS). Monocytic HLA-DR expression serves as a primary endpoint, and other laboratory parameters (e.g. IL-6, IL-10) and clinical outcomes (e.g. postoperative infectious complications, ICU stay time, and mortality) as the secondary endpoints. In addition, some immune indicators, such as high mobility group protein 1 (HMGB1) and regulatory T cell (Treg), possibly related to the mechanism of TEAS, will also be measured. Discussion: The current study is a preliminary mono-centric clinical trial with a non-clinical primary endpoint, expression of mHLA-DR, aiming at determining whether perioperative application of TEAS has a potential to reverse CABG-associated immunosuppression. Although the immediate clinical impact of this study is limited, its results would inform further large sample clinical trial with using relevant patient-centered clinical outcomes as primary endpoints. Trial registration: This study was approved by Ethics Committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine with the number 2016-455-06-01. The results of the trial will be published in an internationally peer-reviewed journal. This study was registered at ClinicalTrials with the Identifier NCT02933996 on 13 October 2016, https://www.clinicaltrials.gov/ct2/show/NCT02933996 Keywords: CABG; TEAS; immunosuppression; mHLA-DR

PLASMA LIPID LEVELS IN SURVIVORS FROM MYOCARDIAL INFARCTION

1964 ◽  
Vol 2 (3) ◽  
pp. 91-93 ◽  
Author(s):  
M. A. Denborough ◽  
P. J. Nestel ◽  
Betty Paterson ◽  
Pam Clarke
Keyword(s):  
Myocardial Infarction ◽  
Plasma Lipid ◽  
Lipid Levels
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