Key result
Selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest resulted in lower ADMA levels compared to standard cardiopulmonary bypass (1.30 vs 1.62 µmol/L), though biomarkers were similar when patients with coronary artery disease were excluded.
Why the study?
This study aimed to compare biomarkers related to endothelial function during selective antegrade cerebral perfusion with moderate hypothermic lower body circulatory arrest versus standard cardiac surgery.
Does selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest affect biomarkers related to endothelial function compared to standard cardiac surgery?
Cohort (n=72)
No
Does selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest affect biomarkers related to endothelial function compared to standard cardiac surgery?
Short periods of moderately hypothermic lower body circulatory arrest during aortic surgery do not appear to adversely affect endothelial function biomarkers compared to standard cardiopulmonary bypass.
May not adversely affect endothelial biomarkers with moderate hypothermic arrest; leaves open need for randomized confirmation.
Aim: This study aims to compare biomarkers related to endothelial function during selective antegrade cerebral perfusion with moderate hypothermic lower body circulatory arrest with that of standard cardiac surgery.Material and Methods: Thirty-six consecutive patients who underwent selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest at 28°C (study group) for aneurysms of the ascending aorta were prospectively compared with 36 patients who underwent standard cardiac surgery (control group) with conventional cardiopulmonary bypass. Nitric oxide, asymmetric dimethylarginine, hydrogen sulfide and total antioxidant capacity status and lactate levels in blood specimens obtained from the vena cava inferior were studied. Clinical results and biochemical parameters were evaluated.Results: Biomarkers related to endothelial function were found to be similar between the groups except for asymmetric dimethylarginine. The asymmetric dimethylarginine levels were lower, while lactate levels were significantly higher compared to the control group. When the patients with coronary artery disease were excluded from the analysis to rule out the predominance of coronary artery disease patients in one group as a confounding factor, the asymmetric dimethylarginine levels were found to be similar between the two subgroups.Conclusion: Low plasma levels of asymmetric dimethylarginine in the study group may have a protective role in endothelial nitric oxide synthesis. When patients with coronary artery disease were excluded from both group, biomarkers related to endothelial function were similar in both groups. We consider that endothelial functions are not affected adversely during short periods of moderately hypothermic lower body circulatory arrest.
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Kubat et al. (2020) conducted a cohort in Ascending aortic aneurysm (n=72). Selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest vs. Standard cardiac surgery with conventional cardiopulmonary bypass was evaluated on Plasma asymmetric dimethylarginine (ADMA) levels (µmol/L) (p=<0.001). Selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest resulted in lower ADMA levels compared to standard cardiopulmonary bypass (1.30 vs 1.62 µmol/L), though biomarkers were similar when patients with coronary artery disease were excluded.
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