Aprotinin, a nonspecific serine protease inhibitor, has been primarily used as a haemostatic drug in cardiac surgery with cardio-pulmonary bypass (CPB). This study investigated the effect of Aprotinin on the post-operative levels of procalcitonin (PCT) and a set of cytokines in patients undergoing pulmonary artery endarterectomy (PEA). We analyzed 60 patients with chronic thromboembolic pulmonary hypertension undergoing PEA. 30 patients (Group A) were treated with Aprotinin (2000000 IU prior anesthesia, then 2000000 IU in CPB prime and 50000 IU per hour continuously); a further 30 patients (Group B) received Tranexamic Acid (1 g before anesthesia, 1 g after full heparin dose and 2 g in CPB prime). PCT, TNFα, IL-1β, IL-6, and IL-8 arterial concentrations were measured from before until 72 hours after surgery. Aprotinin significantly affected early post-PEA plasma PCT. Patients treated with Aprotinin (Group A) had lower peak PCT levels compared to patients in Group B (1.52 ng/ml versus 2.18, p=0.024). Postoperative peak values of PCT and IL- 6 correlated closely in both groups (r=0.78, r=0.83 respectively). Aprotinin attenuates the post-PEA increase of PCT in the same manner as other pro-inflammatory cytokines. Significant correlation between PCT and IL-6 post-surgery may be indicative of an indirect IL-6-mediated pathway of PCT alteration., P. Maruna, ... [et al.]., and Obsahuje seznam literatury
The aim was to investigate: changes of inflammatory, stress and
cardiac response in patients undergoing open heart surgeries up
to five days after the procedure; the association between
inflammatory, stress and cardiac response and whether changes
in a certain marker can predict short-term patient outcome.
Ninety patients were divided into three groups, 30 participants
each (on-pump, off-pump revascularization and valve
replacement group). The following markers were measured:
complete blood count, CRP, IL-6, IL-10, leptin, resistin, monocyte
chemoattractant protein-1 (MCP-1), cortisol, CK and hsTnT in
5 points. Resistin increased in all three groups. Lower IL-10 levels
were found after the surgery and higher levels of leptin and MCP1 in the off-pump than in the on-pump group. Off-pump group
had higher values of IL-6, IL-10, leptin, resistin and MCP-1 and
lower levels of CK and hsTnT 24 after surgery than the on-pump
group. We found significant correlation between MCP-1 and
resistin. The difference between resistin at time points 2 and 3
significantly predicted transfusion needs; while the difference
between CRP and resistin before and at the end of the surgery
together with the difference between leukocytes at the end and
24 hours after the surgery predicted the use of inotropic
agents/vasopressors. Cardiac surgeries cause an increase of
inflammatory, stress and cardiac markers. Only resistin correlated
with MCP-1 which confirms the link between resistin secreted
form infiltrated macrophages and enhanced release of MCP-1.