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The Journal of Cardiovascular Surgery 1999 February;40(1):65-9

lingua: Inglese

Plasma hypox­an­thine ­levels ­during crys­tal­loid and ­blood car­di­o­ple­gias: Warm ­blood car­di­o­plegia ­increases hypox­an­thine ­levels with a ­greater ­risk of oxi­da­tive ­stress

Quinlan G. J., Westerman S. T., Mumby S., Pepper J. R. *, Cutteridge J. M. C.

From the * Depart­ments of Car­di­oth­o­racic Sur­gery and ­Anaesthesia and ­Adult Inten­sive ­Care Royal ­Brompton Hos­pital National ­Heart and ­Lung Insti­tute Impe­rial Col­lege of Sci­ence Tech­nology and Med­i­cine ­London, UK


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Back­ground. ­Patients under­going car­di­o­pul­mo­nary ­bypass (CPB) are sub­jected to ­severe oxi­da­tive ­stress, and fre­quently ­show evi­dence of ­acute ­lung ­injury ­post sur­gery. Asso­ci­a­tions ­between ­acute ­lung ­injury, oxi­da­tive ­stress, and aber­rant ATP catab­o­lism ­have ­been ­made and ­prompted us to con­sider ­whether the ­purine metab­olites xan­thine and hypox­an­thine ­alter sig­nif­i­cantly ­during CPB ­when dif­ferent ­types of car­di­o­plegia are ­used.
Methods. Experi­mental ­design: ret­ro­spec­tive ­follow up ­study on ­stored ­plasma sam­ples ­from ­patients ran­domly ­selected to ­receive ­either ­warm ­blood, ­cold ­blood, or crys­tal­loid car­di­o­plegia. Set­ting: ­adult inten­sive ­care ­unit of ­post grad­uate ­teaching hos­pital. ­Patients: ­thirty-­eight ­patients under­going ­aortic ­valve replace­ment, ­with or ­without ­artery ­grafting. Oper­a­tion was car­ried out by a ­single sur­geon. Inter­ven­tions: all ­patients ­received ­either a homo­graft ­aortic ­valve or a stent­less por­cine ­valve.
­Results. No sig­nif­i­cant dif­fer­ences in xan­thine ­levels at any ­time ­points ­during CPB, or ­between the dif­ferent car­di­o­plegic ­groups. Hypox­an­thine ­levels ­were, how­ever, sig­nif­i­cantly ­higher in ­patients ­receiving ­warm ­blood car­di­o­plegia (74.84±16.715 µM, p=0.0151), and was ­most ­marked at ­time ­point 3 ­when the ­aortic ­cross ­clamp was ­released. ­Patients ­receiving crys­tal­loid car­di­o­plegia ­showed ­higher ­levels of hypox­an­thine (44.56±10.16 µM) ­than ­those ­receiving ­cold ­blood car­di­o­plegia (21.57±7.106 µM).
Con­clu­sions. Con­sid­ering ­these ­data ­together, it sug­gests ­that aber­rant ATP catab­o­lism, char­ac­ter­istic of ­ischaemia/reper­fu­sion, is fur­ther dis­turbed ­during ­warm ­blood car­di­o­plegia ­leading to a ­marked ­increase in ­plasma hypox­an­thine ­levels. ­This has the poten­tial to fur­ther ­increase oxi­da­tive ­stress ­during CPB.

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