Aprotinin reduces cardiac troponin I release and inhibits apoptosis of polymorphonuclear cells during off-pump coronary artery bypass surgery.
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.
Bert
Christophe
C
Department of Anesthesiology, University Hospital Gasthuisberg, Leuven, Belgium. christophe.bert@olvz-aalst.be
De Buck
Frederik
F
Sergeant
Paul
P
Van Hemelrijck
Jan
J
Kasran
Ahmad
A
Van Duppen
Victor
V
Ceuppens
Jan
J
Meyns
Bart
B
Delforge
Michel
M
Wouters
Patrick
P
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
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