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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1998 December;39(6):797-802

lingua: Inglese

Car­diac Tro­ponin T to eval­uate myo­car­dial pro­tec­tion via inter­mit­tent ­cold ­blood or con­tin­uous ­warm ­blood car­di­o­plegia in cor­o­nary ­artery ­bypass ­grafting

Astorri E., Fiorina P., Grattagliano C.**, Medici D.*, Pinelli S., Albertini D., Pincolini S.**, Barboso G.*, Albertini R.

From the Chair of Cardiology Department of Medical Pathology, the *Chair of Heart and Great Vessels Surgery University of ­Parma, and the ** Service of Anesthesia and Resuscitation I General Hospital, ­Parma, ­Italy


Back­ground. The aim of our ­study was to eval­uate the effi­cacy of myo­car­dial pro­tec­tion ­during cor­o­nary ­artery ­bypass ­grafting (­CABG) in ­cold ­blood inter­mit­tent (CBIC) and ­warm con­tin­uous ­blood car­di­o­plegia (­WCBC). To ­assess myo­car­dial ­necrosis, Tro­ponin T, a struc­tural pro­tein ­belonging to the tro­ponin com­plex, was meas­ured. Tro­ponin T is ­released in the ­blood ­stream 4 ­hours ­after myo­car­dial ­damage, and it ­does not ­cross-­react ­with the iso­meric ­form of the skel­etal ­muscle.
­Methods. Our ­study ­involved 20 con­sec­u­tive ­patients, sched­uled for iso­lated ­CABG. ­They ­were ­divided ­into two ­groups: the ­first ­group (10 ­patients; 8 m, 2 f) under­went sur­gery ­with the use of ­CBIC, the ­second ­group (10 ­patients; 9 m, 1 f) ­with ­WCBC. The ­serum ­levels of car­diac Tro­ponin T (cTn-T) ­were all <0.2 μg/l ­before oper­a­tion.
­Results. In the ­CBIC the ­mean cTn-T ­peaked on the 1st day ­after ­CABG, in the ­WCBC ­group the ­first ­peak ­occurred in the 2nd ­hour ­after ­arrival in the inten­sive ­care ­unit, and the ­second ­peak ­occurred on the 4th day post­op­er­a­tively. The ­mean ­serum cTn-T was ­lower in the ­WCBC vs ­CBIC ­group ­from the 1st to the 5th ­day post­op­er­a­tively, ­with a sta­tis­tical dif­fer­ence on the 1st day (p<0.05). In the ­CBIC ­group ­either the cTn-T ­peak ­values (r=0.77; p<0.02) or ­area ­under the con­cen­tra­tion ­curve of cTn-T ­release (r=0.85; p<0.004), ­were ­directly cor­re­lated ­with the ­aortic ­cross-­clamping ­time. ­This was not dem­on­strated in the ­WCBC. CPK and CK-MB ­peaked in ­both ­groups 6 ­hours ­after ­arrival in the inten­sive ­care ­unit and on the 1st day post­op­er­a­tively, ­with ­higher ­values at 6 ­hours in the ­WCBC ­group (p<0.05). The CK-MB/CPK ­ratio was sig­nif­i­cantly ­lower in the ­WCBC ­group at the six ­hours (p<0.05).
Con­clu­sions. The ­results of ­this pre­lim­i­nary ­study sug­gest ­that ­fewer ­necrosis ­markers are ­released ­during ­CABG in the ­WCBC ­group; in the ­CBIC ­group the ­release of cTn-T ­whether meas­ured by ­peak ­serum ­level or by ­area ­under the ­curve, ­shows a sta­tis­ti­cally sig­nif­i­cant cor­re­la­tion ­with ­cross-­clamping ­time. ­Warm ­blood car­di­o­plegia is ­safe and sup­plies ade­quate myo­car­dial pro­tec­tion ­during ­CABG; the ­more pro­longed ­cross-­clamping is, the ­more myo­car­dial pro­tec­tion is ­afforded by ­WCBC.

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