Low density lipoprotein apheresis during cardiopulmonary bypass of hypercholesterolemic patients

Area of Science:

• Cardiovascular Surgery
• Lipidology
• Vascular Biology

Background:

• Ischemia-reperfusion injury during open heart surgery can accelerate atherosclerosis.
• Increased endothelial permeability allows low-density lipoprotein (LDL) influx into the subendothelium, promoting atherosclerotic changes.
• Hypercholesterolemia exacerbates these processes in coronary arteries and bypass grafts.

Purpose of the Study:

• To evaluate the efficacy and safety of LDL apheresis during cardiopulmonary bypass (CPB).
• To minimize LDL influx into the vessel wall before reperfusion.
• To mitigate ischemia-reperfusion-induced atherosclerotic changes.

Main Methods:

• LDL apheresis was performed during CPB in eight hypercholesterolemic patients (LA group).
• A control group of 41 patients underwent standard CPB without apheresis.
• Serum LDL cholesterol levels were measured before and after CPB; safety and graft patency were assessed.

Main Results:

• The LA group showed a significant reduction in LDL cholesterol from 180 +/- 41 mg/dl to 62 +/- 25 mg/dl (59% reduction).
• The control group had a smaller reduction from 139 +/- 32 mg/dl to 117 +/- 41 mg/dl (16% reduction).
• No significant differences were observed in blood loss, coagulation parameters, wound complications, or bypass graft patency between groups.

Conclusions:

• LDL apheresis during CPB is a safe and effective method for substantially lowering serum LDL levels before reperfusion.
• This procedure effectively reduces LDL influx into the vessel wall, potentially mitigating post-operative atherosclerotic changes.
• The technique demonstrates good safety profile and does not compromise early bypass graft patency.