Endothelial dysfunction following coronary artery bypass grafting

Hadem, Johannes; Rossnick, R.; Hesse, Bettina; Herr, Mike; Hansen, Marco Bo; Bergmann, Astrid; Kensah, George; Maess, C.; Baraki, Hassina; Kümpers, Philipp; Lukasz, Alexander; Kutschka, Ingo

doi:10.1007/s00059-018-4708-0

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…The off-pump method of surgical procedures described in our analysis allowed us to minimalize the influence of post-operative inflammatory response on our results. Several studies confirmed that the off-pump surgical revascularization technique omits the risk for inflammatory activation secondary to CBP administration [ 40 – 43 ]. In the Mirhafez et al [ 41 ] study serum cytokines levels in off-pump coronary surgery were lower compared with on-pump method.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

et al. 2022

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Coronary artery bypass revascularization is still the optimal treatment for complex coronary artery disease with good long-term results. The relation between inflammatory activation in the post-operative period and the long-term prognosis was already postulated. The possible predictive role of preoperative inflammatory indexes after the off-pump coronary artery bypass grafting technique on long term survival was the aim of the study. Study population included 171 patients with a median age of 64 years (59–64) operated on using off-pump technique between January and December 2014. Patients enrolled in the current study were followed-up for 8 years. We conducted a multivariable analysis of pre-operative and post-operative inflammatory markers based on analysis of the whole blood count. The overall survival rate was 80% for the total follow-up period, while 34 deaths were reported (30-days mortality rate of 1%). In the multivariable analysis, a pre-operative value of systemic inflammatory response index (SIRI) >1.27 (HR = 6.16, 95% CI 2.17–17.48, p = 0.012) revealed a prognostic value for long-term mortality assessment after off-pump surgery. Preoperative inflammatory activation evaluated by systemic inflammatory reaction index (SIRI) possess a prognostic value for patients with complex coronary artery disease. The SIRI value above 1.27 indicates a worse late prognosis after off-pump coronary artery bypass (AUC = 0.682, p<0.001).

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Section: Discussionmentioning

confidence: 99%

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

et al. 2022

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“…Cardiac surgery induces a sepsis-like syndrome associated with a high degree of endothelial cell dysfunction. Recent studies report drastically increased postoperative levels of endothelial markers in blood such as vascular endothelial cadherin and endocan, which correlate with the severity of endothelial cell injury after cardiac surgery (33,34). Von-Willebrand factor regulates adhesion of immune cells to injured endothelium and has been previously studied in cardiac patients (35).…”

Section: Discussionmentioning

confidence: 99%

Dynamics of Vascular Protective and Immune Supportive Sphingosine-1-Phosphate During Cardiac Surgery

et al. 2021

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IntroductionSphingosine-1-phosphate (S1P) is a signaling lipid and crucial in vascular protection and immune response. S1P mediated processes involve regulation of the endothelial barrier, blood pressure and S1P is the only known inducer of lymphocyte migration. Low levels of circulatory S1P correlate with severe systemic inflammatory syndromes such as sepsis and shock states, which are associated with endothelial barrier breakdown and immunosuppression. We investigated whether S1P levels are affected by sterile inflammation induced by cardiac surgery.Materials and MethodsIn this prospective observational study we included 46 cardiac surgery patients, with cardiopulmonary bypass (CPB, n=31) and without CPB (off-pump, n=15). Serum-S1P, S1P-sources and carriers, von-Willebrand factor (vWF), C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) were measured at baseline, post-surgery and at day 1 (POD 1) and day 4 (POD 4) after surgical stimulus.ResultsMedian S1P levels at baseline were 0.77 nmol/mL (IQR 0.61-0.99) and dropped significantly post-surgery. S1P was lowest post-surgery with median levels of 0.37 nmol/mL (IQR 0.31-0.47) after CPB and 0.46 nmol/mL (IQR 0.36-0.51) after off-pump procedures (P<0.001). The decrease of S1P was independent of surgical technique and observed in all individuals. In patients, in which S1P levels did not recover to preoperative baseline ICU stay was longer and postoperative inflammation was more severe. S1P levels are associated with its sources and carriers and vWF, as a more specific endothelial injury marker, in different phases of the postoperative course. Determination of S1P levels during surgery suggested that also the anticoagulative effect of heparin might influence systemic S1P.DiscussionIn summary, serum-S1P levels are disrupted by major cardiac surgery. Low S1P levels post-surgery may play a role as a new marker for severity of cardiac surgery induced inflammation. Due to well-known protective effects of S1P, low S1P levels may further contribute to the observed prolonged ICU stay and worse clinical status. Moreover, we cannot exclude a potential inhibitory effect on circulating S1P levels by heparin anticoagulation during surgery, which would be a new pro-inflammatory pleiotropic effect of high dose heparin in patients undergoing cardiac surgery.

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“…When we look at the literature, the presence of ischemic areas after CABG surgery, the effects of long-term anesthesia, and high heart rate because of compensation by increasing heart rate instead of increasing stroke volume to increase cardiac output, are expected situations. This may indicate that myocardial oxygen consumption is still high (30).…”

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Koroner Arter Bypass Greft Cerrahi̇si̇ Sonrasi Kardi̇yopulmoner Rehabi̇li̇tasyon Ve Nöromüsküler Elektri̇k Sti̇mülasyonun Fonksi̇yonel Kapasi̇te, Mi̇yokardi̇al Doku Doppleri̇ Üzeri̇ndeki̇ Kisa Dönem Etki̇leri̇

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et al. 2022

Türk Fizyoterapi Ve Rehabilitasyon Dergisi

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Amaç: Önceki çalışmalar, nöromüsküler elektrik stimülasyonunun (NMES) yorgunluk ve nefes darlığına neden olmadan egzersiz kapasitesini arttırdığını göstermiştir. Amacımız koroner arter baypas grefti sonrası NMES'in fonksiyonel kapasite üzerine etkilerini gözlemlemekti. Yöntem: Kırk hasta rastgele grup 1 (egzersiz + NMES) ve grup 2 (egzersiz) olarak iki gruba ayrıldı. Fonksiyonel kapasite, miyokardiyal doku doppler ile 2 dakika yürüme testi (2DYT), otur kalk testi (OKT) ve sol ventrikül diyastolik fonksiyonları analiz edildi. Ayrıca göğüs duvarı ölçümü, hastanede kalış süresi kaydedildi. Sonuçlar: 2DYT (p=0,549) ve OKT (p=0,716) testleri gruplar içinde incelendi, istatistiksel olarak anlamlı artış gözlendi. Grup 1'de sol ventrikül erken dolum oranı grup 2'den daha yüksekti (p=0.0001*). Grup 1'de sol ventrikül erken dolum basıncı grup 2'den daha düşüktü (p=0,013*). Göğüs duvarı ve hastanede kalış süresi hakkında istatistiksel olarak anlamlı bir bulgu yoktu (p>0,05). Tartışma: Buna göre, NMES'in kardiyopulmoner rehabilitasyona (CPR) eklenmesi, sol ventrikül erken dolum oranını olumlu etkiledi ve bu durum taburculuk sırasında miyokardiyal disfonksiyonu da önleyebilir.

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Endothelial dysfunction following coronary artery bypass grafting

Abstract: CABG is associated with prolonged ED, which is determined by the patient's preoperative inflammatory state rather than by CPB modifications.

Cited by 10 publications

References 22 publications

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

Dynamics of Vascular Protective and Immune Supportive Sphingosine-1-Phosphate During Cardiac Surgery

Koroner Arter Bypass Greft Cerrahi̇si̇ Sonrasi Kardi̇yopulmoner Rehabi̇li̇tasyon Ve Nöromüsküler Elektri̇k Sti̇mülasyonun Fonksi̇yonel Kapasi̇te, Mi̇yokardi̇al Doku Doppleri̇ Üzeri̇ndeki̇ Kisa Dönem Etki̇leri̇

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