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Eur J Cardiothorac Surg 2001;20:923-929
© 2001 Elsevier Science NL
a Department of Clinical Chemistry, Sint Antonius Hospital, Nieuwegein, The Netherlands
b Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
c Department of Anesthesiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
Received 19 April 2001; received in revised form 17 July 2001; accepted 20 July 2001.
Corresponding author. Tel.: +31-30-6099111; fax: +31-30-6092528
e-mail: w.gerritsen{at}kcl-azn.demon.nl
Objectives: Oxidative stress and renal dysfunction occur in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG). Whether the same adverse effects also occur during off-pump CABG is the question in this study. Methods: Forty patients, 27 men and 13 women, undergoing elective CABG were included; 20 patients underwent on-pump CABG and 20 patients underwent off-pump CABG. Renal and ischemia/reperfusion injury parameters were studied, as well as malondialdehyde as a parameter for oxidative stress. Results: The renal function measured as the mean urinary creatinine excretion decreased significantly during surgery for the on-pump CABG group from 7.62±4.74 before surgery to 3.07±1.49 mmol/l after surgery, whereas no changes occurred in the off-pump CABG group. The mean urinary concentrations of hypoxanthine, xanthine and malondialdehyde expressed as creatinine ratios for the on-pump group increased significantly from 1.92±1.36, 6.06±3.62 and 0.21±0.07 before surgery to 11.88±5.77, 13.11±6.61 and 0.57±0.31 mmol/mol creatinine, respectively at arrival to the intensive care unit (ICU). During the next time-points, the purines and malondialdehyde decreased to 9.21±7.46, 7.55±3.95 and 0.32±0.13 mmol/mol creatinine, respectively after a 20 h stay at the ICU. For the off-pump CABG group, the mean ratios also increased significantly from 1.71±1.38, 2.01±0.96 and 0.16±0.10 before surgery to 4.73±3.19, 5.15±3.74 and 0.23±0.17 mmol/mol creatinine, respectively at arrival to the ICU. During the next time-points, the ratios of xanthine and malondialdehyde decreased to 3.80±2.92 and 0.24±0.13 mmol/mol creatinine, respectively. The ratio for hypoxanthine reached the highest ratio (6.97±5.67 mmol/mol creatinine) after a 9 h stay at the ICU, after which the ratio decreased to 5.98±5.56 mmol/mol creatinine after a 20 h stay at the ICU. However, all ratios from the on- and off-pump CABG patients still remained elevated compared with preoperative ratios. In addition, all ratios for the on-pump CABG group were elevated significantly at all time-points for xanthine, at time-points T2 and T4 for hypoxanthine and at time-point T2 for malondialdehyde as compared with the off-pump CABG group. Conclusions: Only mild signs of oxidative stress and no renal dysfunction were found during and after off-pump CABG compared with on-pump CABG.
Key Words: Oxidative stress • Ischemia/reperfusion injury • Cardiopulmonary bypass • Purines • Malondialdehyde • Renal function
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