ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2002 April;43(2):153-9

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Troponin I release after CABG surgery using two different strategies of myocardial protection and systemic perfusion

De Paulis R., Penta De Peppo A., Colagrande L., Nardi P., Tomai F., Forlani S., Scafuri A., Piciché M., Chiariello L.

From the Chair of Cardiosurgery University of Rome “Tor Vergata”, Rome, Italy

Background. Controversies ­still ­exist ­over ­the opti­mal tem­per­a­ture ­for ­blood car­di­o­ple­gia ­and system­ic per­fu­sion. This ­study inves­ti­gates ­the ­effect of tem­per­a­ture of ­blood car­di­o­ple­gia ­and system­ic per­fu­sion on ­the ­release of tro­po­nin I ­and oth­er bio­chem­i­cal mark­ers.
Methods. One hun­dred and fif­ty-­four con­sec­u­tive ­patients ­were ran­dom­ly ­assigned to ­one of ­two car­di­o­pleg­ic ­and system­ic per­fu­sion strat­e­gies of ­cold ­blood car­di­o­ple­gia ­with mod­er­ate system­ic hypo­ther­mia (27°C) or tep­id ­blood car­di­o­ple­gia ­with ­mild system­ic hypo­ther­mia (33°C). Cardiac tro­po­nin I ­and oth­er bio­chem­i­cal mark­ers ­were meas­ured at base­line, at ­the ­end of sur­gery, at 12 ­hours ­and dai­ly there­af­ter. A ­two-­way ANCO­VA ­for repeat­ed meas­ure ­was per­formed to ­test ­the ­effect of car­di­o­ple­gia on ­enzyme ­release inde­pen­dent­ly of var­i­ables ­that ­were dif­fer­ent ­between ­the ­two ­groups.
Results. The ­time ­course of dis­mis­sion of tro­po­nin I, crea­tine ­kinase MB, ­and lac­tate dehy­drog­e­nase ­were sig­nif­i­cant­ly low­er ­with tep­id ­blood car­di­o­ple­gia ­and ­mild system­ic per­fu­sion inde­pen­dent­ly of ­the num­ber of dis­tal anas­to­mos­es, ­CPB ­time, ­cross ­clamp ­time or ­total vol­ume of car­di­o­ple­gia. There ­were no dif­fer­enc­es ­between ­the ­two ­groups in ­the ­release of ­total crea­tine ­kinase, aspar­tate trans­am­i­nase ­and ala­nine trans­fe­rase.
Conclusions. Both strat­e­gies of myo­car­dial pro­tec­tion ­and system­ic per­fu­sion guar­an­tee sub­clin­i­cal ­minor myo­car­dial dam­age. The strat­e­gy of tep­id ­whole ­blood car­di­o­ple­gia ­and ­mild system­ic hypo­ther­mia ­seems to pre­serve myo­car­di­um bet­ter ­than ­whole ­blood ­cold car­di­o­ple­gia.