The effects of cardiopulmonary bypass on systemic and coronary levels of von Willebrand factor.
Von Willebrand factor antigen (vWF Ag) is a marker of endothelial injury which has been shown to rise during surgical procedures, including cardiopulmonary bypass (CPB). The aim of this study was to determine whether intermittent aortic cross-clamping during CPB causes the release of vWF Ag from the coronary vascular bed, which would suggest coronary vascular endothelial cell perturbation. Fifteen consecutive patients undergoing CPB with aortic cross-clamping during coronary artery bypass surgery and/or valve replacement by the same surgeon were studied. Paired venous and coronary sinus samples were taken pre- and post-thoracotomy, prior to cross-clamping on CPB, and 1, 5 and 10 minutes after release of the aortic cross-clamp. Plasma vWF Ag (IU/ml) was measured by ELISA. Venous vWF Ag measured prior to skin incision was 0.75 +/- 0.11 IU/ml (mean +/- SEM) and fell to 0.53 +/- 0.07 IU/ml after institution of CPB but prior to aortic cross-clamping (P < 0.01 vs pre-incision sample). Coronary sinus vWF Ag measured prior to aortic cross-clamping was 0.54 +/- 0.06 IU/ml (P = NS vs paired venous sample). At 1, 5 and 10 min after release of the aortic cross-clamp there was a progressive rise in vWF Ag in both venous and coronary sinus samples (1 min: 0.67 +/- 0.05 IU/ml vs 0.75 +/- 0.10 IU/ml, 5 min: 0.73 +/- 0.07 IU/ml vs 0.76 +/- 0.09 IU/ml, 10 min: 0.74 +/- 0.08 IU/ml vs 0.79 +/- 0.09 IU/ml; P = NS venous vs coronary sinus, respectively). Levels of vWF Ag were highest immediately prior to the termination of CPB (venous: 0.95 +/- 0.12 IU/ml; coronary sinus: 0.91 +/- 0.14 IU/ml). We conclude that cardiac surgery using CPB with aortic cross-clamping is associated with a progressive rise in coronary sinus and venous levels of vWF Ag.(ABSTRACT TRUNCATED AT 250 WORDS)
Holdright
D R
DR
Royal Brompton National Heart & Lung Hospital, London, UK.
Hunt
B J
BJ
Parratt
R
R
Segal
H
H
Clarke
D
D
Taggart
D
D
Bennett
G
G
Collins
P
P
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000941:Antigens / Q000097:blood*; D001021:Aortic Valve; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D003250:Constriction; D003331:Coronary Vessels / Q000378:metabolism / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood*; D004730:Endothelium, Vascular / Q000378:metabolism; D006350:Heart Valve Prosthesis; D006400:Hematocrit; D006801:Humans; D007527:Isoenzymes; D008875:Middle Aged; D008943:Mitral Valve; D011182:Postoperative Care; D011300:Preoperative Care; D014680:Veins; D014841:von Willebrand Factor / Q000032:analysis* / Q000276:immunology
D000941:Antigens; D015415:Biomarkers; D007527:Isoenzymes; C029417:Von Willebrand antigen; D014841:von Willebrand Factor; D003402:Creatine Kinase