ACTA CARDIOLOGICA

Background - The presence of adhesions after heart operations increases the risk of life-threatening damage to the heart and extracardiac grafts. Infections, tissue injury and inflammations are suspected aetiologic agents. The main purpose of our study is to evaluate the effect of an antiinflammatory agent piroxicam on the formation of retrosternal and pericardial adhesions in a rabbit model. Material and methods - 23 of forty-two New Zealand white rabbits were labelled as group P (piroxicam group) and the others as group C (n = 19, control group). All animals were subjected to median sternotomy and abrasion was applied to the epicardium and pericardium. Piroxicam was given only to group P animals 10 mg/kg/day intramuscularly on the day of operation and twice daily for 2 days postoperatively. All animals were sacrificed on the 10(th) postoperative day. After cardiectomy, the pericardium was totally excised; retrosternal and pericardial adhesions were evaluated and scored. t-PA (tissue plasminogen activator), PAI-I (plasminogen activator inhibitor-I) levels and pericardial tissue myeloperoxidase activities were measured. Results - More severe retrosternal and pericardial adhesions were observed in the control group (P < 0.05). Mean levels of t-PA were higher in the study group than in the control group (P < 0.05). Mean levels of PAI-I were lower in the study group (P < 0.05). Hence pericardial fibrinolytic capacity was significantly higher in the piroxicam group than in the control group. Myeloperoxidase activities in the pericardium were significantly lower in the study group than in the control group (P < 0.05). Conclusion - The use of piroxicam in the perioperative period prevents inflammation, preserves the fibrinolytic capacity of the pericardium and decreases the postoperative pericardial and retrosternal adhesions

ACTA CARDIOLOGICA

Objective - The aim of the study was to investigate sleep disturbances of cardiac surgery patients with or without elevated S100B levels. Methods and results - Twenty-two patients with serum S100B > 0.3 mu g/l (study group) 12 hours after cardiac surgery with cardiopulmonary bypass and 23 patients with serum S100B < 0.3 (control group) were investigated in a prospective study. They were evaluated with the use of objective sleep tests. Cardiopulmonary bypass has negatively affected the sleep characteristics in the postoperative period for both groups. Maintenance wakefulness test, total sleep time, total activity score and sleep efficiency scores were significantly shorter in the study group in the postoperative period. Sleep latency, percentage of wakefulness after sleep onset, daytime napping episodes and total nap duration in the same period were significantly higher than in the control group. Conclusion - Cardiac surgery affects a patient's sleep characteristics. Patients with elevated S100B values have more sleep disturbances after cardiac surgery than patients with normal S100B values

CIRCULATION JOURNAL

Background Trimetazidine is an anti-ischemic agent that is used to treat angina and it has cardioprotective effects without inducing any significant hemodynamic changes. It inhibits the long-chain mitochondrial 3-ketoacyl coenzyme A thiolase enzyme in the myocyte and can improve cardiac mitochondrial metabolism, as well as scavenge free radicals. The aim of this double-blind prospective randomized study was to investigate the effect of preoperative use of trimetazidine on the reduction of oxidative stress during coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods and Results The study group (group T) and the control group (group C) each comprised 12 patients. Pretreatment began 2 weeks before CABG with trimetazidine (60 mg/day po); the control group did not receive any medication. Serial blood samples were collected before and after CPB for measurement of the serum concentrations of these major endogenous antioxidant enzyme systems, which are markers for oxidative degradation of the cellular membranes; postoperative levels were significantly different between the groups (p < 0.05). There were no significant difference in hemodynamic values. Conclusion The findings suggest that Pretreatment with trimetazidine alleviates malondialdehyde production and preserves endogenous antioxidant capacity during CABG with CPB and cardioplegic arrest

HEART SURGERY FORUM

Background. Cardiac surgery is associated with an inflammatory response that may cause myocardial dysfunction after cardiopulmonary bypass. We examined the efficacy of pentoxifylline to attenuate the cardiopulmonary bypass-induced inflammatory response during heart operations. Methods. In a prospective, randomized study, 30 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (group P, n = 15) (continuous infusion of 1.5 mg/kg per hour during operation) or not (group C [control], n = 15). Blood samples for measurements of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, and IL-10 were taken from the arterial line in both groups at 5 different time points. Results. TNF-alpha, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a higher increase in the control group (P < .05). Conclusions. Our results indicate that pentoxifylline infusion during cardiac surgery inhibits the proinflammatory cytokine release caused by cardiopulmonary bypass

HEART SURGERY FORUM

Background: Cardiopulmonary bypass may lead to many inflammatory responses that may cause myocardial dysfunction after open heart surgery. We aimed to investigate the effect of preoperative pentoxifylline treatment to reduce the occurrence of cardiopulmonary bypass-induced inflammatory response. Methods: In a prospective, randomized study, 40 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (study group, n = 21) or not (control group, n = 19). Pretreatment with pentoxifylline (800 mg/day orally) was started 5 days before the operation. Blood samples for measurements of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8 from the arterial line, and venous blood samples for creatine kinase (CK) and CK isoenzyme fraction MB (CK-MB) were taken in both groups at 5 different time points. Hemodynamic parameters were measured with the thermodilution technique. Results: TNF-alpha, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a greater increase in the control group (P < .05). There were no significant differences between the groups for the values of CK-MB and hemodynamic parameters. Conclusions: We conclude that pretreatment with oral pentoxifylline before cardiac surgery inhibits proinflammatory cytokine release caused by cardiopulmonary bypass and has some beneficial effects in protecting the myocardium during the cardioplegic arrest period in open-heart surgery, without affecting postoperative hemodynamics

THORACIC AND CARDIOVASCULAR SURGEON

Background: Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass grafting (CABG). This study was designed to evaluate whether the levels of preoperative and postoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) are predictors of postoperative paroxysmal atrial fibrillation in patients who undergo coronary artery bypass surgery. Methods: A total of 117 patients were prospectively evaluated for new-onset AF after coronary operation. Plasma NT-proBNP values in all patients were measured at five different time points. Results: AF occurred during the hospitalization period in 33 patients (28.2%). Significantly higher NT-proBNP levels in the preoperative examination were recorded in patients who developed AF postoperatively compared with patients without postoperative AF (329.36 +/- 82.93 vs. 230.67 +/- 59.93 pg/ml, p < 0.05). Although we detected some higher values in the other group of patients with AF (at T1, T2, T3, T4), the difference was not statistically significant compared to the normal rhythm group. Conclusion: The main finding of the current study is a positive correlation between high levels of preoperative NT-proBNP and the risk of new-onset AF after CABG surgery

ACTA CARDIOLOGICA

Objective - The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of calcium dobesilate (CLS2210) on the biochemical markers of myocardial injury during open-heart surgery, and to determine if it has any myocardial protective effects. Methods - Twenty-four patients undergoing elective cardiac surgery were included in this study and randomized into two groups. CLS2210 was given orally to 12 patients for 14 days before the operation (CD group), but not to the other 12 patients (control group). Serum CK, CK-MB, myoglobin and troponin-T levels were measured from venous blood samples before and after the operation for evaluation of the effect of this drug against myocardial damage. Blood samples were also taken from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB), and 2 and 15 minutes after the removal of the cross-clamp in order to measure the lactate levels and calculate the lactate extraction of the myocardium. Results - First, CK-MB levels in patients of the CD group were significantly lower than those of the control group (p < 0.05) at the 2nd and 18th postoperative hour. Third, there was a significant difference in lactate extraction calculation values between the groups at the 2nd minute after removal of the cross-clamp (p < 0.05). Conclusions - We concluded that preoperative use of CLS2210 has some beneficial effects in protecting the myocardium and decreasing the myocardial injury during the cardioplegic arrest period in open-heart surgery

MINERVA CHIRURGICA

Aim. According to some reports the destruction the integrity of the pleura during acute myocardial infarction (AMI) harvesting during coronary surgery may also impair respiratory function in the postoperative period. The purpose of this study was to evaluate the influence of preserved integrity of pleura on respiratory function in patients undergoing coronary artery bypass grafting (CABG). Methods. One hundred and forty-three patients who had on-pump-CABG operation with pedunculated LIMA graft were divided to 2 groups. The first group is the study group that pleura opened (group OP; N=69), and the other group is that their pleura protected (group C, N=74). All patients were evaluated with using respiratory function test parameters (functional vital capacity [FVC], force expiratory volume %-at the 1(st) second [FEV1%] in the preoperative period and on the 7(th) postoperative day). Respiratory problems, blood drainage amounts and used blood products in the postoperative period were measured. Results. Preoperative FVC values were not different between the two groups (3.08+/-0.5 in group C and 3.37+/-0.7 L in OP group) (P>0.05). On the VII postoperative day this parameter did not show any significant difference between the groups (2.80+/-0.6 in group C and 2.75+/-0.5 liter in OP group) (P>0.05). Preoperative FEV1% values did not show any difference (77.6+/-4.6% and 76.0+/-2.7% in OP and C groups respectively. There was no significant difference between the postoperative FEV1% values (71.8+/-5.1% and 73.4+/-6.3% respectively) (P>0.05). Patients with protected pleura had significantly lower blood drainage and whole blood unit transfusion (P<0.05). Conclusion. Preservation of the pleural integrity during LIMA harvesting significantly reduces postoperative bleeding but not affects pulmonary functions

HEART SURGERY FORUM

Objective. Cognitive brain dysfunction after open heart surgery is a serious complication caused by cardiopulmonary bypass (CPB). The presence of gaseous and/or particulate emboli in the CPB circuit and cerebral hypoperfusion may be the causes of neurologic problems after cardiac operations. Methods. In this prospective study we examined 42 consecutive cardiac surgery patients ( 24 mitral valve replacement [MVR] and 18 coronary artery bypass grafting [CABG] patients). In addition to determination of clinical measurements, cognitive brain function was measured objectively by P300 auditory-evoked potentials before operation, at day 7, and at 4-month follow-up. Electroencephalographic evaluations were also performed. Results. In preoperative measures there was no difference between the groups ( peak latencies in the MVR group were 324 +/- 8 milliseconds; CABG group, 318 +/- 6 milliseconds; P >.05). At day 7, cognitive P300 auditory-evoked potentials were significantly impaired ( prolonged) in both groups compared to preoperative values ( MVR group, 347 +/- 7 milliseconds; CABG group, 342 +/- 7 milliseconds; P .05 compared to preoperative values). One week and 4 months after surgery no difference between the 2 groups could be found ( P >.05). Conclusion. Postoperative patients had prolonged P300 values according to the preoperative measurements and we have not found any difference between the groups whether cardiac chambers were opened or not

HEART SURGERY FORUM

Background: Trimetazidine is an anti-ischemic agent with cardioprotective effects. The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of trimetazidine on the biochemical markers of myocardial injury during open heart surgery and to determine if it has any myocardial protective effects. Methods: Thirty patients undergoing coronary artery bypass grafting surgery, received either trimetazidine (study group, n = 15) or not (control group, n = 15). Pretreatment began 2 weeks before the operation with trimetazidine (60 mg/day orally), and the control group received no medication. We measured the levels of serum creatine kinase (CK), CK isoenzyme MB (CK-MB), myoglobin, and troponin T in venous blood samples obtained before and after the operation to evaluate the effect of this drug against myocardial damage. We also took serial blood samples from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB) and at 2 and 15 minutes after the removal of the cross-clamp to measure lactate levels and calculate the lactate extraction of the myocardium. Results: Postoperative levels of myoglobin, troponin T, CK, and CK-MB were significantly lower in the trimetazidine group than in the control group (P < .05). There was also a significant difference in the values for the lactate extraction calculation between the groups at minute 2 after the removal of the cross-clamp (P < .05). Conclusion: We conclude that pretreatment with trimetazidine has some beneficial effects in protecting the myocardium and decreasing myocardial injury during the cardioplegic arrest period in open heart surgery without affecting postoperative hemodynamics