Myocardial oxidative stress, and cell injury comparing three different techniques for coronary artery bypass grafting.
OBJECTIVE
Oxidative stress as a result of reperfusion injury is a known causative factor of cardiac muscle injury. In the peripheral blood as well in the coronary sinus, oxidative stress parameters and cardiac biomarkers were measured to investigate the different levels of oxidative stress during three different CABG techniques; MCABG (with minimal prime volume and warm blood cardioplegia) that was newly introduced in our hospital, versus OPCAB, versus our current standard, conventional CABG (CCABG, consisting of high volume prime and cold crystalloid cardioplegia). Concomitantly, cardiac biomarkers were measured to detect myocardial cell injury.


METHODS
Thirty patients scheduled for CABG with the intention to treat three-vessel disease were randomly assigned for CCABG, MCABG or OPCAB. Perioperatively, plasma levels of malondialdehyde (MDA) as a marker of oxidative stress, and the allantoin/uric acid ratio (A/U ratio) as a marker of antioxidant activity were measured in the ascending aorta (Aa), and in the coronary sinus (Cs), simultaneously. Additionally peripheral (Aa) blood levels of heart fatty acid binding protein (HFABP), troponin T, CPK and CKMB as markers of myocardial injury were obtained.


RESULTS
The MCABG group had significantly lower MDA levels in the Cs compared to the CCABG group, respectively, to the OPCAB group (p=0.04 and p=0.03). At all time points the A/U ratio in the CCABG group remained significantly higher in the Cs as well in the Aa samples compared to the MCABG and the OPCAB group (p<0.001, respectively, p<0.001, for both groups). HFABP and troponin T showed consistent curves compared to the CPK figure over time in all groups.


CONCLUSIONS
In this study coronary sinus blood levels of oxidative stress parameters were consistently higher compared to peripheral blood levels. The levels were lowest in the MCABG study group. In this group also the lowest levels cardiac biomarkers of myocardial injury were found.
van Boven
Wim-Jan P
WJ
Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands. w.boven@antonius.net
Gerritsen
Wim B
WB
Driessen
Antoine H
AH
Morshuis
Wim J
WJ
Waanders
Frans G
FG
Haas
Fred J
FJ
van Dongen
Eric P
EP
Aarts
Leon P
LP
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D003402:Creatine Kinase / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D018384:Oxidative Stress / Q000502:physiology*; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism
D015415:Biomarkers; D020107:Troponin T; D008315:Malondialdehyde; D003402:Creatine Kinase