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Circulating adhesion molecules in cardiac operations: influence of high-dose aprotinin
J Boldt1, C Osmer, E Schindler
1Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Insights
Aprotinin did not significantly alter circulating adhesion molecules during cardiac surgery with cardiopulmonary bypass. This suggests aprotinin may not be effective in mitigating the inflammatory response associated with CPB.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Pharmacology
Background:
- Cardiopulmonary bypass (CPB) triggers a systemic inflammatory response.
- Circulating adhesion molecules like ELAM-1, VCAM-1, and ICAM-1 are key in CPB-related inflammation.
- Aprotinin, an antiprotease, may protect endothelial integrity during CPB.
Purpose of the Study:
- To investigate the effect of aprotinin on circulating adhesion molecules during cardiac surgery with CPB.
- To assess if high-dose aprotinin can modulate the inflammatory response mediated by adhesion molecules.
Main Methods:
- Prospective study of 40 patients undergoing elective cardiac surgery.
- Randomized into two groups: high-dose aprotinin (n=20) and no aprotinin (n=20).
- Measured circulating adhesion molecules (cICAM-1, cELAM-1, cVCAM-1) via ELISA at multiple time points.
Main Results:
- Hemodilution during CPB decreased all measured adhesion molecules in both groups.
- On postoperative day 1, cICAM-1 and cELAM-1 levels returned to baseline in both aprotinin and no-aprotinin groups.
- No significant difference in adhesion molecule levels was observed between the groups post-CPB.
Conclusions:
- High-dose aprotinin did not significantly impact circulating adhesion molecule levels post-CPB.
- Aprotinin may not effectively prevent the CPB-induced inflammatory response mediated by these adhesion molecules.
- Further research is needed to explore alternative strategies for managing CPB-related inflammation.
Abstract:
Cardiac operations using cardiopulmonary bypass (CPB) are associated with a systemic inflammatory response most likely attributable to the release of various inflammatory mediators and activation of complement or coagulation cascade. In addition, (circulating) adhesion molecules, such as endothelial leukocyte adhesion molecule (ELAM-1), vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1), appear to be of central importance in the CPB-related inflammatory process. In this situation, antiproteases, such as aprotinin, may help to prevent damage of endothelial integrity. In a prospective study, 40 consecutive patients undergoing elective cardiac operation were randomly divided into two groups (with 20 patients in each group): in group 1 "high-dose" aprotinin was used (2 million IU of aprotinin before CPB, 500,000 IU/h until end of operation, 2 million IU added to the prime) (with aprotinin), and in group 2 no aprotinin was given (without aprotinin). Circulating adhesion molecules (cICAM-1, cELAM-1, and cVCAM-1) were measured from arterial blood samples using ELISA after induction of anesthesia (baseline), during CPB, at the end of the operation, 5 hours after CPB, and on the first postoperative day. The two groups were comparable concerning their biometric profile and CPB data. Baseline values of circulating adhesion molecules were within normal range and similar in both groups. During CPB, hemodilution resulted in a decrease in all circulating adhesion molecules. On the first postoperative day, cICAM-1 (with aprotinin, 215 +/- 32 ng/mL; without aprotinin, 230 +/- 40 ng/mL) and cELAM-1 (with aprotinin, 28 +/- 6 ng/mL; without aprotinin, 31 +/- 6 ng/mL) returned to baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)