Systemic release of thrombomodulin, but not from the cardioplegic, reperfused heart during open heart surgery.
Thrombomodulin is a potential marker of endothelial injury. Plasma thrombomodulin was measured in concomitant arterial and coronary sinus samples in 9 patients undergoing elective coronary artery bypass surgery with cardiopulmonary bypass (CPB, 88 +/- 14 min) (mean +/- SD) and cold, crystalloid, antegrade cardioplegia (44 +/- 14 min). Arterial thrombomodulin was 17 +/- 6 ng/ml before surgery, and decreased to 10 +/- 5 ng/ml after heparinization (p < 0.008 compared to initial value). During CPB thrombomodulin increased, with a maximal level of 23 +/- 7 ng/ml (p < 0.008 vs initial value) 40 min after aortic declamping. No difference between arterial and coronary sinus concentrations was detected during reperfusion of the heart. In conclusion, plasma thrombomodulin is decreased by heparin, and increased during CPB. Consequently, thrombomodulin may be used to evaluate endothelial injury during CPB. However, as there is no specific intracoronary release of thrombomodulin during reperfusion, thrombomodulin is not a suitable marker of coronary endothelial injury after cardioplegia.
Valen
G
G
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Sigurdardottir
O
O
Vaage
J
J
D000368:Aged; D015415:Biomarkers; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D003331:Coronary Vessels; D017558:Elective Surgical Procedures; D004699:Endocardium / Q000293:injuries / Q000378:metabolism*; D004730:Endothelium, Vascular / Q000293:injuries / Q000378:metabolism*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D006493:Heparin / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D017534:Radial Artery; D018180:Thrombomodulin / Q000097:blood*
D015415:Biomarkers; D018180:Thrombomodulin; D006493:Heparin