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Albumin and Cardioprotection in On-Pump Cardiac Surgery-A Post Hoc Analysis of a Randomized Trial
Hanna Vlasov1, Akseli Talvasto1, Seppo Hiippala1
1Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Plasma albumin administration significantly reduced cardiac muscle damage marker (creatinine kinase-myocardial band mass) in patients undergoing on-pump cardiac surgery. Both endogenous and exogenous albumin demonstrated cardioprotective effects.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biochemistry
Background:
- On-pump cardiac surgery carries a risk of myocardial injury.
- Creatinine kinase-myocardial band mass (CK-MBm) is a marker of cardiac damage.
- Albumin's role in cardioprotection during cardiac surgery requires further elucidation.
Purpose of the Study:
- To quantitatively assess the cardioprotective potency of plasma albumin.
- To evaluate the impact of albumin on creatinine kinase-myocardial band mass (CK-MBm) levels.
- To investigate albumin's effect in on-pump cardiac surgery patients.
Main Methods:
- Post hoc analysis of a double-blinded randomized clinical trial involving 1,386 patients.
- Comparison of 4% albumin versus Ringer's acetate for cardiopulmonary bypass priming and fluid replacement.
- Measurement of plasma albumin concentrations and CK-MBm levels.
Main Results:
- Intraoperative albumin concentrations were significantly higher in the albumin group.
- Creatinine kinase-myocardial band mass (CK-MBm) was significantly lower in the albumin group compared to the Ringer group (24.3 ± 33.0 μg/L vs 32.0 ± 34.8 μg/L, p < 0.001).
- Albumin administration was associated with a 41% reduction in CK-MBm in the whole cohort.
Conclusions:
- Both endogenous and exogenous albumin exhibit cardioprotective properties.
- Albumin administration reduces myocardial injury, as indicated by lower CK-MBm levels post-cardiac surgery.
- Albumin is a potential therapeutic agent for cardioprotection in on-pump cardiac surgery.
Objectives:
To study the quantitative potency of plasma albumin on cardioprotection in terms of creatinine kinase-myocardial band mass (CK-MBm) in on-pump cardiac surgery.
Design:
Post hoc analysis of a double-blinded randomized clinical trial.
Setting:
Single-center study in the Helsinki University Hospital.
Participants:
A total of 1,386 adult on-pump cardiac surgical patients.
Intervention:
Administration of 4% albumin (n = 693) or Ringers acetate (n = 693) for cardiopulmonary bypass priming and volume replacement intraoperatively and postoperatively during the first 24 hours.
Measurements And Main Results:
Albumin concentration was measured preoperatively and intraoperatively (after protamine administration), and CK-MBm on the first postoperative morning. Multivariate linear regression analyses were measured in the whole cohort and the Ringer group. Plasma albumin concentration did not differ between the groups preoperatively (Ringer v albumin: 38.3 ± 5.0 g/L v 38.6 ± 4.5 g/L; p = 0.171) but differed intraoperatively (29.5 ± 5.2 g/L v 41.5 ± 6.0 g/L; p < 0.001). Creatinine kinase-myocardial band mass was higher in the Ringer (32.0 ± 34.8 μg/L) than in the albumin group (24.3 ± 33.0 μg/L) (p < 0.001). Aortic cross-clamping time associated with CK-MBm in the whole cohort (standardized β = 0.376 [95% CI 0.315-0.437], p < 0.001) and the Ringer group (β = 0.363 [0.273-0.452]; p < 0.001). Albumin administration in the whole cohort (β = -0.156 [-0.201 to -0.111]; p < 0.001) and high intraoperative albumin concentration in the Ringer group (β = -0.07 [-0.140 to -0.003]; p = 0.04) associated with reduced CK-MBm. Compared with ischemia-induced increase in CK-MBm, albumin's potency to reduce CK-MBm was 41% in the whole cohort (β-value ratio of -0.156/0.376) and 19% in the Ringer group (β-value ratio of -0.07/0.363).
Conclusion:
Both endogenous and exogenous albumin appear to be cardioprotective regarding CK-MBm release in on-pump cardiac surgery.
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