Attenuation of cardiopulmonary bypass–derived inflammatory reactions reduces myocardial reperfusion injury in cardiac operations

In cardiac operations endopeptidase (protease) inhibitor may be beneficial in reducing myocardial injury when administered in the cardiopulmonary bypass prime. Nafamostat mesilate was evaluated in 20 patients who underwent coronary artery bypass grafting. The patients were divided into a control gro...

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Published in:The Journal of thoracic and cardiovascular surgery 1996, Vol.111 (1), p.29-35
Main Authors: Sawa, Yoshiki, Shimazaki, Yasuhisa, Kadoba, Keishi, Masai, Takashi, Fukuda, Hirotsugu, Ohata, Toshihiro, Taniguchi, Kazuhiro, Matsuda, Hikaru
Format: Article
Language:English
Subjects:
Cardiopulmonary Bypass - adverse effects
CD18 Antigens - analysis
Complement Hemolytic Activity Assay
Coronary Artery Bypass
Creatine Kinase - blood
Cytokines - blood
Fibrinolysin - antagonists & inhibitors
Guanidines - therapeutic use
Humans
Interleukin-1 - blood
Interleukin-6 - blood
Interleukin-8 - blood
Isoenzymes
Malondialdehyde - blood
Middle Aged
Myocardial Reperfusion Injury - prevention & control
Neutrophil Activation
Serine Proteinase Inhibitors - therapeutic use
Tumor Necrosis Factor-alpha - analysis
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Summary:In cardiac operations endopeptidase (protease) inhibitor may be beneficial in reducing myocardial injury when administered in the cardiopulmonary bypass prime. Nafamostat mesilate was evaluated in 20 patients who underwent coronary artery bypass grafting. The patients were divided into a control group ( n = 10) and a nafamostat group ( n = 10). Nafamostat (2 mg/kg per hour) was continuously given during cardiopulmonary bypass in the nafamostat group. The age, number of grafts, cardiopulmonary bypass time, and aortic crossclamp time were similar between groups. In the control group, neither tumor necrosis factor-α nor interleukin-1 levels showed any significant change during cardiopulmonary bypass, whereas interleukin-6 and interleukin-8 levels, percent expression of adhesion molecule (CD18) on neutrophils, and CH 50 assay results increased significantly during cardiopulmonary bypass. As compared with the control group, the nafamostat group showed significantly lower levels of interleukin-6 (123 ± 57 versus 40 ± 22 pg/ml, respectively) and interleukin-8 (96 ± 13 versus 66 ± 14 pg/ml, respectively). The nafamostat group showed a significantly lower difference of CH 50 assay results and malondialdehyde levels between coronary sinus blood and arterial blood and peak values of creatine kinase MB (43 ± 12 IU/L versus 19 ± 6 IU/L) during the postoperative course compared with findings in the control group. These results demonstrated that inflammatory reactions induced by cardiopulmonary bypass had adverse effects on myocardial recovery after aortic crossclamping and that nafamostat mesilate given during cardiopulmonary bypass appeared to reduce myocardial reperfusion injury by attenuating such inflammatory reactions. Attenuation of inflammatory reactions of cardiopulmonary bypass should be considered in the strategy of myocardial protection. (J T horac C ardiovasc S urg 1996;111:29-35)
ISSN:0022-5223
1097-685X
DOI:10.1016/S0022-5223(96)70398-7