title: Aprotinin reduces cardiac troponin I release and inhibits apoptosis of polymorphonuclear cells during off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  In addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting.
  
  
  METHODS
  A prospective randomized clinical trial.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifty patients were randomized to control (n = 25) or aprotinin treatment (n = 25) groups.
  
  
  METHODS
  Aprotinin was given as a loading dose (2 x 10(6) KIU) followed by a continuous infusion at 5 x 10(5) KIU/h until skin closure.
  
  
  RESULTS
  Blood samples for cardiac troponin I; interleukin-6, interleukin-8, and interleukin-10; tumor necrosis factor alpha; and elastase were taken after anesthesia induction, completion of revascularization, and 6 hours, 12 hours, and 24 hours after revascularization. Blood samples were taken to assess for apoptosis in polymorphonuclear cells. Baseline plasma levels for cardiac troponin I did not differ between groups but were significantly lower in aprotinin-treated patients at the time of revascularization (p = 0.03) and 6 hours (p = 0.004) and 24 hours (p = 0.03) later. Aprotinin significantly reduced apoptosis in polymorphonuclear cells compared with control-treated patients (p = 0.04). There were no differences in plasma cytokine or elastase levels between groups.
  
  
  CONCLUSIONS
  The authors conclude that aprotinin reduces perioperative cardiac troponin I release and attenuates apoptosis in polymorphonuclear cells but has no significant effects on plasma cytokine levels in patients undergoing off-pump coronary artery bypass graft surgery.
authors.affiliation: Department of Anesthesiology, University Hospital Gasthuisberg, Leuven, Belgium. christophe.bert@olvz-aalst.be
authors.forename: Christophe
authors.initials: C
authors.lastname: Bert
authors.forename: Frederik
authors.initials: F
authors.lastname: De Buck
authors.forename: Paul
authors.initials: P
authors.lastname: Sergeant
authors.forename: Jan
authors.initials: J
authors.lastname: Van Hemelrijck
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kasran
authors.forename: Victor
authors.initials: V
authors.lastname: Van Duppen
authors.forename: Jan
authors.initials: J
authors.lastname: Ceuppens
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.forename: Michel
authors.initials: M
authors.lastname: Delforge
authors.forename: Patrick
authors.initials: P
authors.lastname: Wouters
mesh_terms: D000368:Aged; D017209:Apoptosis / Q000187:drug effects*; D007611:Aprotinin / Q000494:pharmacology*; D015415:Biomarkers / Q000097:blood; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D009504:Neutrophils / Q000166:cytology / Q000187:drug effects*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D006490:Hemostatics; D015850:Interleukin-6; D016209:Interleukin-8; D019210:Troponin I; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D007611:Aprotinin; D019272:Leukocyte Elastase