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Hadem J, Rossnick R, Hesse B, Herr M, Hansen M, Bergmann A, Kensah G, Maess C, Baraki H, Kümpers P, Lukasz A, Kutschka I. Endothelial dysfunction following coronary artery bypass grafting : Influence of patient and procedural factors. Herz 2018; 45:86-94. [PMID: 29774399 DOI: 10.1007/s00059-018-4708-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Angiopoietin-2 (Angpt2) mediates endothelial dysfunction (ED) following coronary artery bypass grafting (CABG). Its triggers are, however, poorly understood. METHODS We examined the time course of ED beyond the early phase of postoperative recovery in 75 patients following CABG with a special focus on different cardiopulmonary bypass (CPB) modes as potential triggers of Angpt2 release. RESULTS Nine patients (12.0%) underwent off-pump coronary artery bypass (OPCAB), 31 patients (41.3%) received minimized extracorporeal circulation (MECC), and 35 patients (46.6%) were operated on with (conventional) CPB. Angpt2 levels steadily increased across the observation period (1.7 [1.4-2.1] to 3.4 [2.5-6.1] ng/ml, p < 0.001). Angpt2 levels did not differ between the MECC and CPB groups (p = 0.564). There was no difference between MECC and CPB patients regarding net fluid balance (p = 0.821) and other surrogate markers of postoperative ED. The magnitude of Angpt-2 increase correlated more strongly with baseline C‑reactive protein (r = 0.459, p < 0.001) than with any other parameter. Hospital length of stay correlated more strongly with baseline Angpt2 levels (r = 0.512, p = 0.005) than with follow-up Angpt2 levels and appeared not to be influenced by CPB mode (p = 0.428). CONCLUSION CABG is associated with prolonged ED, which is determined by the patient's preoperative inflammatory state rather than by CPB modifications.
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Affiliation(s)
- J Hadem
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. .,Department of Gastroenterology and Hepatology, University Clinic Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - R Rossnick
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - B Hesse
- Medizinische Klinik D, Universitätsklinikum Münster, Domagkstraße 5, 48149, Münster, Germany
| | - M Herr
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.,Klinik für Thorax‑, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - M Hansen
- Klinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 30120, Magdeburg, Germany
| | - A Bergmann
- Klinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 30120, Magdeburg, Germany
| | - G Kensah
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.,Klinik für Thorax‑, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - C Maess
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - H Baraki
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.,Klinik für Thorax‑, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - P Kümpers
- Medizinische Klinik D, Universitätsklinikum Münster, Domagkstraße 5, 48149, Münster, Germany
| | - A Lukasz
- Medizinische Klinik D, Universitätsklinikum Münster, Domagkstraße 5, 48149, Münster, Germany
| | - I Kutschka
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.,Klinik für Thorax‑, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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