Effect of Selective Antegrade Cerebral Perfusion with Moderately Hypothermic Lower Body Circulatory Arrest on Biomarkers Related to Endothelial Function

Yıl 2020, Cilt: 4 Sayı: 1, 48 - 55, 02.03.2020

Emre Kubat , Aytaç Çalışkan Ertekin Utku Ünal , Suzan Emel Usanmaz Başak Soran Türkcan , Ahmet Sarıtaş Emine Demirel-yılmaz Ayşen İrez Aksöyek

https://doi.org/10.30565/medalanya.642337

Cited By: 1

Öz

Aim: This study aims to compare biomarkers related to endothelial function during selective antegrade cerebral perfusion with moderate hypothermic lower body circulatory arrest with that of standard cardiac surgery.

Material and Methods: Thirty-six consecutive patients who underwent selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest at 28°C (study group) for aneurysms of the ascending aorta were prospectively compared with 36 patients who underwent standard cardiac surgery (control group) with conventional cardiopulmonary bypass. Nitric oxide, asymmetric dimethylarginine, hydrogen sulfide and total antioxidant capacity status and lactate levels in blood specimens obtained from the vena cava inferior were studied. Clinical results and biochemical parameters were evaluated.

Results: Biomarkers related to endothelial function were found to be similar between the groups except for asymmetric dimethylarginine. The asymmetric dimethylarginine levels were lower, while lactate levels were significantly higher compared to the control group. When the patients with coronary artery disease were excluded from the analysis to rule out the predominance of coronary artery disease patients in one group as a confounding factor, the asymmetric dimethylarginine levels were found to be similar between the two subgroups.

Conclusion: Low plasma levels of asymmetric dimethylarginine in the study group may have a protective role in endothelial nitric oxide synthesis. When patients with coronary artery disease were excluded from both group, biomarkers related to endothelial function were similar in both groups. We consider that endothelial functions are not affected adversely during short periods of moderately hypothermic lower body circulatory arrest.

Anahtar Kelimeler

Nitric oxide, asymmetric dimethylarginine, hydrogen sulfide, Thorax surgery, Antegrade cerebral perfusion

Antegrad Serebral Perfüzyon ve Distal Ilımlı Hipotermik Sirkülatuar Arrest Tekniğinin Endotel Fonksiyonuna İlişkin Biyobelirteçler Üzerine Etkisi

Öz

Amaç: Bu çalışma, antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuararrest tekniğinin endotel fonksiyonuna ilişkin biyobelirteçler üzerine etkisini standart kalp cerrahisi ile karşılaştırmayı amaçlamaktadır.

Materyal-Metod: Asendan aort anevrizması için 28 ° C' da selektif antegrad serebral perfüzyon ve orta derecede hipotermik alt vücut dolaşım durması uygulanan 36 hasta (standart çalışma grubu), konvansiyonel kardiyopulmoner bypass ile standart kalp ameliyatı uygulanan (kontrol grubu) 36 hasta prospektif olarak karşılaştırıldı. Vena kava inferiordan elde edilen kan örneklerinde nitrik oksit, asimetrik dimetilarginin, hidrojen sülfit ve toplam antioksidan kapasite durumu ve laktat seviyeleri incelenmiştir. Klinik sonuçlar ve biyokimyasal parametreler değerlendirildi.

Bulgular: Endotel fonksiyonuyla ilgili biyobelirteçler, asimetrik dimetilarjinin dışındaki gruplar arasında benzer bulundu. Asimetrik dimetilarjinin düzeyleri düşüktü, laktat düzeyleri ise kontrol grubuna göre anlamlı derecede yüksek bulundu. Kontrol gruptaki koroner arter hastalarının baskınlığını nedeniyle çıkan sonuçlarda kafa karıştırıcı bir faktör olarak düşünülerek koroner arter hastaları analiz dışında bırakıldığında, asimetrik dimetilarjinin düzeylerinin, iki alt grup arasında benzer olduğu bulundu.

Sonuç: Çalışma grubundaki düşük plazma asimetrik dimetilarjinin seviyeleri, endotelyal nitrik oksit sentezinde koruyucu bir role sahip olabilir. Koroner arter hastalığı olan hastalar her iki gruptan da dışlandığında, endotel fonksiyonuna bağlı biyobelirteçler her iki grupta da benzerdi. Bu sebeple antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuar arrest tekniğinin kısa dönemde endotel fonksiyonlarını etkilemediğini düşünmekteyiz.

Anahtar Kelimeler

Antegrad serebral perfüzyon, nitrik oksit, asimetrik dimetil arjinin, hidrojen sülfit, Toraks cerrahisi

Kaynakça

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