Importance of erythropoietin in brain protection after cardiac surgery: a pilot study.
BACKGROUND
Neurologic complications after cardiac operations present an important medical problem, as well as a financial burden. They increase the morbidity and hospital stays of patients who have otherwise undergone successful heart operations. The current protocols for perioperative brain protection against ischemic events are not optimal. Because of its different pleiotropic mechanisms of action, recombinant human erythropoietin might provide neuroprotection.


METHODS
In this study, we included 20 patients who were older than 18 years and required surgical revascularization of the heart with the use of the heart-lung machine. Ten patients received 3 consecutive intravenous doses (24,000 IU) of recombinant human erythropoietin (rHuEpo). Neurologic and magnetic resonance imaging (MRI) examinations were done before and in the first 5 days after surgery.


RESULTS
The erythropoietin-treated and control groups were comparable with respect to study protocol outcomes: number of coronary artery bypass grafts (3.3 and 3.2 grafts/patient, respectively), operative time (4.12 and 4.6 hours), and transfusion volume per patient (708 and 674 mL). The groups were also comparable with respect to blood pressure values at all stages of the operation. MRI scans revealed that 4 of 10 patients from the control group had fresh ischemic brain lesions after open heart surgery. None of the patients in the erythropoietin-treated group had fresh ischemic brain lesions.


CONCLUSIONS
Although the number of patients was small, the results regarding brain protection with rHuEpo are encouraging. rHuEpo is a promising neuroprotective agent.
Department for Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.
Nikola
N
Lakic
Katarina
K
Surlan
Ales
A
Jerin
Bernard
B
Meglic
Nina
N
Curk
Matjaz
M
Bunc
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D011300:Preoperative Care; D011994:Recombinant Proteins; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D011994:Recombinant Proteins; D004921:Erythropoietin