Key result
Cardiopulmonary bypass is linked to higher, more prolonged postoperative oxidative stress than non-bypass surgery.
Why the study?
Markers of oxidative stress during cardiopulmonary bypass in cardiovascular surgery have not been adequately evaluated due to their reactive and short-lived nature.
Does cardiovascular surgery involving cardiopulmonary bypass increase oxidative stress compared to surgery without cardiopulmonary bypass in patients undergoing elective cardiovascular surgery?
Observational (n=21)
No
Does cardiovascular surgery involving cardiopulmonary bypass increase oxidative stress compared to surgery without cardiopulmonary bypass in patients undergoing elective cardiovascular surgery?
p-value: p=<0.05
Cardiovascular surgery involving cardiopulmonary bypass causes significant oxidative damage that correlates with the duration of bypass, suggesting that avoiding or shortening CPB time may reduce oxidative stress.
Oxidative stress assessment via FRAS 4 during CPB may aid monitoring; leaves open its clinical utility pending prospective validation.
The transient systemic low perfusion that occurs during cardiovascular surgery leads to oxidative stress and the production of free radicals. A systemic increase of various markers of oxidative stress has been shown to occur during cardiopulmonary bypass (CPB). However, these markers have not been adequately evaluated because they seem to be reactive and short-lived. Here, oxidative stress was measured using the free radical analytical system (FRAS 4) assessing the derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP). Blood samples were taken from 21 patients undergoing elective cardiovascular surgery. CPB was used in 15 patients, and abdominal aortic aneurysm (AAA) surgery without CPB was performed in 6. Measurements of d-ROMs and BAP were taken before surgery, 1 day, 1 week, and 2 weeks after surgery, and oxidative stress was evaluated. The d-ROM level increased gradually after cardiovascular surgery up to 2 weeks. Over time, the d-ROM level after surgery involving CPB became higher than that after AAA surgery. This difference reached statistical significance at 1 week and lasted to 2 weeks. The prolongation of CPB was prone to elevate the d-ROM level whereas the duration of the aortic clamp in AAA surgery had no relation to the d-ROM level. The BAP was also elevated after surgery, and was positively correlated with the level of d-ROMs. In this study, patients who underwent cardiovascular surgery involving CPB had significant oxidative damage. The production of ROMs was shown to depend on the duration of CPB. Damage can be reduced if CPB is avoided. When CPB must be used, shortening the CPB time may be effective in reducing oxidative stress.
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Kanaoka et al. (2010) conducted an observational in Elective cardiovascular surgery (n=21). Cardiopulmonary bypass (ECC) vs. Abdominal aortic aneurysm (AAA) surgery without CPB was evaluated on Postoperative d-ROMs (derivatives of reactive oxygen metabolites) levels at 2 and 3 weeks (p=<0.05). Cardiovascular surgery involving cardiopulmonary bypass resulted in significantly higher and more prolonged oxidative stress, as measured by d-ROM levels at 2 and 3 weeks postoperatively, compared to surgery without bypass.
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