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Paradoxical response of plasma lipoprotein(a) in patients undergoing cardiopulmonary bypass
D S Sgoutas1, O M Lattouf, D C Finlayson
1Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322.
Insights
Major surgery significantly alters plasma lipids and proteins. Lipoprotein(a) uniquely increases during cardiopulmonary bypass, posing potential risks despite other lipid levels normalizing.
Area of Science:
- Biochemistry
- Cardiovascular Surgery
- Clinical Chemistry
Background:
- Plasma lipid, lipoprotein, and apolipoprotein levels typically decrease following major surgery.
- Cardiopulmonary bypass (CPB) used in cardiac surgery involves hemodilution, potentially affecting these levels.
Purpose of the Study:
- To investigate the dynamic changes in lipids, lipoproteins, apolipoproteins, C-reactive protein, and albumin during and after cardiac surgery with CPB.
- To assess the impact of CPB on these biochemical markers.
Main Methods:
- Timed arterial blood samples were collected from 22 patients before, during, and after CPB.
- Analysis included lipids, lipoproteins, apolipoproteins AI and B, C-reactive protein, and albumin.
- Results were corrected for hemodilution to evaluate true physiological responses.
Main Results:
- A rapid decrease in most lipids and lipoproteins (except lipoprotein(a)) was observed during CPB, with partial recovery by 72 hours.
- Lipoprotein(a) levels significantly increased during CPB and remained elevated postoperatively.
- C-reactive protein initially decreased but markedly increased postoperatively; albumin showed transient changes.
Conclusions:
- Lipoprotein(a) elevation during CPB is a distinct finding, potentially clinically significant due to its atherogenic and thrombogenic properties.
- The observed changes in lipids and proteins are not solely due to hemodilution.
- Understanding these alterations is crucial for managing patients undergoing cardiac surgery with CPB.
Abstract:
Plasma lipid, lipoprotein and apolipoprotein levels are known to decrease after major surgery. Coronary artery bypass surgery additionally involves use of extracorporeal circulation by use of a cardiopulmonary bypass pump, which necessitates hemodilution due to saline dextrose infusion to prime the pump. To investigate changes in lipids, lipoproteins and apolipoproteins as well as changes in C-reactive protein and albumin we conducted a study on 22 patients undergoing cardiac surgery involving cardiopulmonary bypass. Timed arterial blood samples were taken before, during and after cardiopulmonary bypass. At the onset and during cardiopulmonary bypass a rapid and significant fall was observed in all lipids and lipoproteins except lipoprotein(a) with recovery to near basal levels by 72 h for cholesterol, triglycerides, high density lipoprotein cholesterol and albumin, while apolipoproteins AI and B remained below basal levels during the postoperative period up to 72 h. In contrast, lipoprotein(a) levels increased at the onset, doubled during cardiopulmonary bypass and remained elevated postoperatively. On the other hand, C-reactive protein levels fell at the onset and during cardiopulmonary bypass but they became markedly elevated postoperatively. When results were corrected for hemodilution, the response patterns remained unchanged. As lipoprotein(a) is both atherogenic and thrombogenic, its elevation during cardiopulmonary bypass may be clinically important.
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