Ezhar KORKMAZ ERSÖZ, Mehmet Halit ANDAÇ, Yasemin HACANLI, Mehmet Salih AYDIN, Reşat DİKME

Kaplı ve Kaplı Olmayan Oksijenatörlerde Kardiopulmoner Sistemlerin Antioksidanlar Üzerine Etkileri

Amaç: Kardiyopulmoner Bypass'ta (KPB) kaplı ve kaplı olmayan sistemlerin antioksidanlar üzerindeki etkilerine ve elde ettiğimiz bilgiler doğrultusunda klinik uygulamalarda olası cerrahi yöntemlere katkı sağlamayı amaçlıyoruz. Yöntem: Açık kalp cerrahisi ameliyatına dahil edilen 15 kaplı ve 15 kaplı olmayan oksijenatörden toplam 30 hastadan anestezi, pompa girişi, kros klemp başlangıcı, kros klemp sonu, pompa sonu olmak üzere 5 farklı zamanda alınan kan çalışmaya dahil edildi. Bulgular: Demografik verilere göre çalışmaya dahil edilen kaplı oksijenatörler (grup I) ve kaplı olmayan oksijenatörler (grup II) olarak; 63.3'ü kadın, 36.7'si erkek olmak üzere 30 hastaya işlem uygulandı. Hasta gruplarının klemp süresi, toplam antioksidan kapasite1 ve 3 (TAOK1, TAOK 3), hemoglobin (Hgb), hematokrit (Hct) ve trombosit (Plt) değerleri cinsiyete göre gruplar arasında anlamlı farklılık göstermedi (p>0,05) ). Sonuç: Kardiyopulmoner Bypass (KPB) sırasında kaplı ve kaplı olmayan preoperatif, intraoperatif ve postoperatif dönemde Hgb, Hct ve Plt ve TAOK değerlerini etkilemediği sonucuna varıldı. Objective: We aim to contribute to the effects of coated and uncoated systems on antioxidants in Cardiopulmonary Bypass (CPB) and to possible surgical methods in clinical applications in line with the information we have obtained. Material And Method: Blood taken at 5 different times including anesthesia, pump entry, cross-clamp start, cross-clamp end, pump end from a total of 30 patients from 15 coated and 15 non-coated oxygenators included in open heart surgery surgery were included in the study. Result:As coated oxygenators (group I) and uncoated oxygenators (group II) included in the study according to demographic data; Thirty patients, 63.3 female and 36.7 male, underwent the procedure. Cross-clemp duration, total antioxidant capacity1 and 3 (TAOK1, TAOK 3), hemoglobin (Hgb), hematocrit (Hct) and platelet (Plt) values of the patient groups according to gender were not significantly different between the groups (p>0.05). Conclusion: It was concluded that coated and uncoated systems during Cardiopulmonary Bypass (CPB) did not affect Hgb, Hct, Plt and TAOK values in the preoperative, intraoperative and postoperative periods.

Anahtar Kelimeler:

Kardiopulmoner Bypass, Kalp-Akciğer Makinesi, Total Antioksidan Kapasite, Kaplı ve Kapsız Oksijenatör

Effect of Cardiopulmoner Systems on Antioxidants in Coated and Uncoated Oxigenators

Background: We aim to contribute to the effects of coated and uncoated systems on antioxidants in Cardiopulmonary Bypass (CPB) and to possible surgical methods in clinical applications in line with the information we have obtained. Materials and Methods: Blood taken at 5 different times including anesthesia, pump entry, cross-clamp start, cross-clamp end, pump end from a total of 30 patients from 15 coated and 15 non-coated oxygenators included in open heart surgery surgery were included in the study. Results: As coated oxygenators (group I) and uncoated oxygenators (group II) included in the study according to demographic data; Thirty patients, 63.3 female and 36.7 male, underwent the procedure. Cross-clemp duration, total antioxidant capacity1 and 3 (TAOK1, TAOK 3), hemoglobin (Hgb), hematocrit (Hct) and platelet (Plt) values of the patient groups according to gender were not significantly different between the groups (p>0.05). Conclusions: It was concluded that coated and uncoated systems during Cardiopulmonary Bypass (CPB) did not affect Hgb, Hct, Plt and TAOK values in the preoperative, intraoperative and posto-perative periods.

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1. Paç M, ed. Kalp ve Damar Cerrahisi 1 ed. MN Medikal& Nobel Basım Yayın Tic. ve San. Ltd. Şti., P. Ankara, 2004;115-151, 116-121,14.
2. Crow MT, Mani K, Nam YJ, Kitsis RN. The mitochondrial death pathway and cardiac myocyte apoptosis. Circ Res. 2004; 95(10): 957-70
3. Halliwell B, Gutteridge JMC. Free Radicals in Biology and Medicine (4nd ed), Oxford University Press 2007.
4. Peluso I, Morabito G, Urban L, Ioannone F, Serafini M. Oxida-tive stress in atherosclerosis development: the central role of LDL and oxidative burst. Endocr Metab Immune Disord Drug Targets. 2012; 12(4): 351–60.
5. 33-Jensen SJK. Oxidative stress and free radicals. Journal of Molecular Structure (Theochem), 2003; 666-667: 387-92
6. Gulcin I. Antioxidant and antiradical activities of L-Carnitine. 2206; Life Sci. 78(8): 803–11
7. Rahman K. Studies on free radicals, antioxidants, and co-factors. Clinical interv aging. 2007; 2(2): 219-36
8. Roth GA, Huffman MD, Moran AE, Feigin V, Mensah GA, Naghavi M, et al. Global and regional patterns in cardiovascu-lar mortality from 1990 to 2013. Circulation. 2015;132(17):1667-78
9. Hammon JW, Extracorporeal circulation. In: Cohn LH, editor. Cardiac Surgery in Adult. Boston: McGraw- Hill, 350-414, 2008.
10. Ekim H, Kutay V, Başel H, Turan E, Hazar A, Karadağ M. Açık Kalp Cerrahisi Sonrası Kanamaya Bağlı Revizyon Operasyonla-rı. Van Tıp Dergisi. 2004; 11(4): 119- 123.
11. Öztürk S, Koroner arter baypas greftleme operasyonlarında pulsatil ve nonpulsatil akımın sistematik etkilerinin karşılaştı-rılması, uzmanlı tezi, Pamukkale Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Anabilim Dalı, Denizli, 2011.
12. Uslu A, Yigit R. Açık Kalp Cerrahisinde, Heparin Dozu Ve Ser-best Plazma Hemoglobini Arasındaki İlişki, Cerrahpaşa Tıp Dergisi; 32: 37-42, 2001.
13. Kim HK, Son HS, Fang HY, Park SY, Hwang CM, Sun K. The effects of pulsatile flow upon renal tissue perfusion during cardiopulmonary bypass: a comparative study of pulsatile and nonpulsatile flow. ASAIO J; 51:30-36, 2005
14. Alkan T, Akçevin A, Ündar A, Türkoğlu H, Paker T, Aytaç A. Effects of pulsatile and nonpulsatile perfusion on vital organ recovery in pediatric heart surgery: a pilot clinicl study. ASAIO J; 52:530-535, 2006.
15. Alkan T et al. Benefits of pulsatile perfusion on vital organ recovery during and after pediatric open heart surgery. ASA-IO J; 53:651-654, 2007.
16. Habib RH, Zacharias A Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopul-monary bypass in the adult: should current practice be chan-ged? J Thorac Cardiovasc Surg; 125: 1438-50, 2003.
17. Swaminathan M, Philips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. The association of lowest hematocrit during cardiopulmonary bypass wih acute renal injury after coronay artery bypass surgery. Ann Thorac surg; 76: 784-91, 2003.
18. Ranucci M et al. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. Ann Thorac Surg; 80: 2213-20, 2005.
19. 19. Parikh CR, Schaub JA. Acute kidney injury: steroids for prevention of AKI after cardiopulmonary bypass. Nature Re-views Nephrology 2015; 11: 509-10.
20. Iwahashi H, Yuri K, Nosé Y. Development of the oxygenator: past, present, and future. JArtificial Organs 2004; 7: 111-20.
21. Wagner R, Piler P, Uchytil B, et al. Systemic inflammatory response syndrome is reduced by preoperative plasmath-rombo-leukocyte aphaeresis in a pig model of cardiopulmo-nary bypass. Biomedical Papers of the Medical Faculty of Pa-lacky University in Olomouc, 2016; 160.
22. Parikh CR, Schaub JA. Acute kidney injury: steroids for pre-vention of AKI after cardiopulmonary bypass. Nature Re-views Nephrology 2015; 11: 509-10.
23. Hsu LC. Heparin-coated cardiopulmonary bypass circuits: current status. Perfusion 2001;16:417-28
24. Matsuo M, Kitada H, Iida H, Okamoto T. An experimental study in prolonged use of heparin-coated cardiopulmonary bypass circuits. Jpn J Extra-Copreal Technol. 2000;27:57–9.
25. Ricci M, Karamanukian HL, Abraham R, Von Fricken K, D’Ancona G, Choi S. Stroke in octogenarians undergoing co-ronary artery surgery with and without cardiopulmonary by-pass. Ann Thorac Surg 2000; 69: 1471-5.
26. Remadi, JP, Rakotoarivello, Z, Marticho, P, et al. Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary by-pass: a randomized prospective trial. J Thoracic Cardiovasc Surg 2004; 128: 436–441.
27. Weber N, Wendel HP, Ziemer G. (2001) Hemocompatibility of Heparin-Coated Surfaces and The Role of Selective Plasma Protein Adsorption, Elsevier Science Ltd, s;432-437.
28. Biglioli P, Cannata A, Alamanni F, Naliato M, Porqueddu M, Zanobini M, Tremoli E, Parolari A. Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflam-mation, hemostasis and oxidative stress. Eur J Cardiothorac Surg 2003;24:260–9
29. Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocar-dial antioxidantsin ischemia-reperfusion injury. Cardiovasc Res 2000;47: 446–56.
30. Gerritsen WBM, van Boven WJP, Driessen AHG, Haas FJLM, Aarts LPHJ. Off-pump versus on-pump coronary artery by-pass grafting: oxidative stress and renal function. Eur J Cardi-othorac Surg 2001;20:923–9
31. Hammadh M, Fan Y, Wu Y, Hazen SL, Tang WW. Prognostic Value of Elevated Serum Ceruloplasmin Levels in Patients with Heart Failure. J Card Fail 2014;20(12): 946-52.
32. M. Zakkar, G. Guida, M.-S. Suleiman, and G. D. Angelini, “Cardiopulmonary bypass and oxidative stress,” Oxidative Medicine and Cellular Longevity, vol. 2015, Article ID 189863, 8 pages, 2015
33. H. Cai and D. G. Harrison, “Endothelial dysfunction in cardio-vascular diseases: the role of oxidant stress,” Circulation Re-search, vol. 87, no. 10, pp. 840–844, 2000.
34. Callister M. E., Burke-Gaffney A., Quinlan G. J., et al. Extracel-lular thioredoxin levels are increased in patients with acute lung injury. Thorax. 2006;61(6):521–527.
35. U. Mentese, O. V. Dogan, I. Turan et al., “Oxidant-antioxidant balance during on-pump coronary artery bypass grafting,” The Scientific World Journal, vol. 2014, Article ID 263058, 5 pa-ges, 2014.
36. K. Berg, R. Haaverstad, R. Astudillo et al., “Oxidative stress during coronary artery bypass operations: importance of sur-gical trauma and drug treatment,” Scandinavian Cardiovascu-lar Journal, vol. 40, no. 5, pp. 291–297, 2006
37. A. Gonenc, A. Hacışevki, H. R. Griffiths, M. Torun, B. Bakka-loglu, and B. Simsek, “Free radical reaction products and anti-oxidant capacity in beating heart coronary artery surgery compared to conventional bypass,” Biochemistry, vol. 76, no. 6, pp. 677–685, 2011.
38. K. Miwa, A. Igawa, K. Nakagawa, T. Hirai, and H. Inoue, “Con-sumption of vitamin E in coronary circulation in patients with variant angina,” Cardiovascular Research, vol. 41, no. 1, pp. 291–298, 1999.
39. Doğan A., Turker FS. The Effect of On-Pump and Off-Pump Bypass Operations on Oxidative Damage and Antioxidant Pa-rameters. Oxid Med Cell Longev. 2017;2017:8271376.