Cardioprotective Effect of Aprotinin on Myocardial Ischemia/Reperfusion Injury During Cardiopulmonary Bypass

• Published in: Circulation Journal 2006, Vol.70(11), pp.1432-1436
• Main Authors: Karaca, Pelin, Konuralp, Cüneyt, Enc, Yavuz, Süzer, Asuman, Sokullu, Onur, Ayoglu, Umut, Cicek, Sertac
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aprotinin; Aprotinin - pharmacology; Aprotinin - therapeutic use; Cardiopulmonary bypass; Cardiopulmonary Bypass - methods; Coronary Artery Disease - surgery; Creatine Kinase, MB Form - blood; Double-Blind Method; Heart - drug effects; Heart - physiopathology; Heart Arrest, Induced - adverse effects; Humans; Hypothermia - physiopathology; Ischemia; L-Lactate Dehydrogenase - blood; Male; Middle Aged; Prospective Studies; Reperfusion injury; Reperfusion Injury - blood; Reperfusion Injury - drug therapy; Reperfusion Injury - physiopathology; Reperfusion Injury - prevention & control; Serine Proteinase Inhibitors - pharmacology; Serine Proteinase Inhibitors - therapeutic use; Troponin; Troponin T - blood
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.70.1432

Background Aprotinin is a serine protease inhibitor used extensively in cardiac operations to reduce postoperative bleeding. It also has cardioprotective effects in ischemia/reperfusion injury. In this study, the effects of aprotinin on the release of cardiac markers were evaluated in patients who had good ventricular function and were undergoing coronary artery bypass grafting with cardiopulmonary bypass (CPB). Methods and Results Eighty male patients with an ejection fraction ≥40%, were randomized into either an aprotinin (Group-I; n=40) or control (Group-II; n=40) group. Patients in the aprotinin group received the full Hammersmith doses of aprotinin (2×106 KIU pre-CPB, 2×106 KIU at pump prime, 500,000 KIU/h during CPB), whereas the patients in the control group received only saline solutions. Cardiac troponin-I (cTnI) levels were measured before surgery, immediately after surgery, and at postoperative 6th, 12th, 24th h and 5th day. Creatine kinase (CK)-MB measurements were performed at the same time except for the postoperative 5th day. Cardiac index (CI), mixed venous oxygen saturation and lactate dehydrogenase (LDH) measurements were also performed. Conclusion Although all patients were in reasonable condition, less myocardial enzyme leakage occurred on the aprotinin group, suggesting that aprotinin has a protective effect on the myocardium beyond that achieved with blood cardioplegia and systemic hypothermia. Because of aprotinin's effects on multiple targets of metabolism, its protective value might increase in more complicated cases. (Circ J 2006; 70: 1432 - 1436)