caa a22 4500 477098460 CHVBK 20180405111534.0 cr unu---uuuuu 170330e19961201xx s 000 0 eng 10.1007/BF02616286 doi (NATIONALLICENCE)springer-10.1007/BF02616286 Influence of ischemic preconditioning and blood cardioplegia protection on postischemic endothelial activation in coronary bypass surgery [Elektronische Daten] [G. Steinhoff, M. Karck, J. Cremer, T. Ahnsel, D. Hollander, A. Haverich] Einfluß von ischämischer Präkonditionierung und Blutkardioplegieprotektion auf die postischämische Endothelaktivierung in der Koronarchirurgie Summary: Background: Hypothermic ischemia in open heart surgery and cardiopulmonary bypass involve a postischemic in-flammatory reaction caused by an activation of leukocytes and endothelia with the systemic release of cytokines and adhesion molecules. The present study addresses the question, if an amelioration of postischemic endothelial activation in the heart could be achieved by means of cardioplegic protection or ischemic preconditioning. In a randomized prospective study patients underwent a normothermic preconditioning procedure either followed by crystalloid or blood cardioplegia during coronary bypass surgery. Methods: Patients (n=28) were included and randomized in the study according to defined criteria: Group A received St. Thomas cardioplegia, group B cold blood cardioplegia. Ischemic precon-ditioning was performed twice at normothermia under a cardiopulmonary bypass (CPB) for 5 min followed by 10 min of reperfusion before coronary aortic bypass graft (CABG) using St. Thomas (group C) or blood cardioplegia (group D) hypothermic protection. In coronary sinus blood and arterial blood myocardial (creatine-kinase myoglobin [CK-MB]) and endothelial activation (endothelin, IL-6, IL-8, sE-selectin, soluble vascular adhesion molecule-1 [sVCAM-1], soluble intercellular adhesion molecule-1 [sICAM-1]) parameters were investigated 1, 3, 6, 9, 12, and 24 h after coronary reperfusion. Results: 1) Parameters of myocardial injury (CK-MB, myoglobin) revealed increased levels at 1 h and 9 to 12 h after CABG. Levels at 12 h were lower in group B and D as compared to A and C. 2) Cytokines (IL-6, IL-8) showed increased levels 3 h after reperfusion with no difference between study groups. 3) Soluble adhesion molecules (E-selectin, VCAM-1, ICAM-1) were found increased in all groups 6 to 12 h after reperfusion. Lower levels were present in group D for E-selectin and VCAM-1. Conclusions: The results indicate a sequence of cytokine and adhesion molecule release as a potential pathomechanism of myocardial reperfusion injury. Gradual decrease in the release of endothelial adhesion molecules in late myocardial injury was noted for blood cardioplegia and ischemic preconditioning. Amelioration of endothelial activation by means of preconditioning and blood cardioplegia may improve heart muscle recovery in open heart surgery with borderline ischemia time and organ dysfunction. Blackwell Science Ltd, 1996 Cytokines nationallicence soluble adhesion molecules nationallicence reperfusion injury nationallicence coronary bypass surgery nationallicence ischemic preconditioning nationallicence blood cardioplegia nationallicence Zytokine nationallicence lösliche Adhäsionsmoleküle nationallicence Reperfusionsschaden nationallicence Koronarchirurgie nationallicence ischämische Präkonditionierung nationallicence Blut-Kardioplegie nationallicence Steinhoff G. Department of Heart and Vascular Surgery, University Kiel, Germany aut Karck M. Department of Heart and Vascular Surgery, University Kiel, Germany aut Cremer J. Department of Heart and Vascular Surgery, University Kiel, Germany aut Ahnsel T. Department of Heart and Vascular Surgery, University Kiel, Germany aut Hollander D. Department of Heart and Vascular Surgery, University Kiel, Germany aut Haverich A. Department of Heart and Vascular Surgery, University Kiel, Germany aut Acta Chirurgica Austriaca Springer-Verlag 28/6(1996-12-01), 354-358 0001-544X 28:6<354 1996 28 10353 https://doi.org/10.1007/BF02616286 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02616286 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Steinhoff G. Department of Heart and Vascular Surgery, University Kiel, Germany aut NATIONALLICENCE 700 1- Karck M. Department of Heart and Vascular Surgery, University Kiel, Germany aut NATIONALLICENCE 700 1- Cremer J. Department of Heart and Vascular Surgery, University Kiel, Germany aut NATIONALLICENCE 700 1- Ahnsel T. Department of Heart and Vascular Surgery, University Kiel, Germany aut NATIONALLICENCE 700 1- Hollander D. Department of Heart and Vascular Surgery, University Kiel, Germany aut NATIONALLICENCE 700 1- Haverich A. Department of Heart and Vascular Surgery, University Kiel, Germany aut NATIONALLICENCE 773 0- Acta Chirurgica Austriaca Springer-Verlag 28/6(1996-12-01), 354-358 0001-544X 28:6<354 1996 28 10353 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer