Murat GÜVENER, Şahin BOZOK, Ekrem BAYAR, Cevdet FURAT, Gökhan İLHAN, Mustafa YILMAZ

L-karnitinin koroner arter baypas greftleme sonrası miyokard fonksiyonlarına etkisi

Amaç: Bu çalışmada koroner arter baypas greftleme yapılan hastalarda L-karnitinin ameliyat sonrası kardiyak performans, morbidite ve komplikasyonlar üzerindeki etkisi değerlendirildi. Çalışma planı: Nisan 2005 - Haziran 2008 tarihleri arasında koroner arter baypas greftleme planlanan toplam 60 hasta (36 erkek, 24 kadın; ort. yaş 60.6 yıl; dağılım 57-65 yıl) prospektif olarak üç farklı miyokard koruma stratejisinden birine randomize edildi. Grup A’ya (n=20) antegrad kristaloid kardiyopleji, Grup B'ye (n=20) antegrad kan kardiyoplejisi ve Grup C’ye (n=20) karnitin ile birlikte antegrad kan kardiyoplejisi uygulandı. Laktat dehidrogenaz (LDH), kreatinin fosfokinaz (CPK), kreatinin fosfokinaz-miyokardiyal bant (CK-MB) ve Troponin-I için ameliyat sırasında koroner sinüsten ve postoperatif periferik venöz hattan KPB öncesi, KPB’da ve postoperatif 1, 6, 12, 24 ve 48 saat sonra kan numuneleri alındı. CPK, CK-MB ve Troponin-T seviyelerinin seviyeleri immünoassay yöntemi ile incelendi. Bulgular: Karnitin verilen hastaların kalp debisi, kardiyak indeksi, sağ ventrikül ve sol ventrikül atım işi kardiyopulmoner baypastan hemen sonra ve ameliyat sonrası birinci saatte anlamlı olarak düzeldi (p=0.01). Troponin-T düzeyleri ameliyattan 12 saat sonra tüm hastalarda azalırken, bu değişim en belirgin Grup C’de idi (p=0.001). Sonuç: Kardiyopleji sırasında intravenöz karnitin takviyesi, koroner arter baypas greftleme sonrası kardiyak fonksiyon ve metabolik parametrelerin iyileşmesinde daha iyi sonuçlar vermektedir.

L-carnitine on myocardial function after coronary artery bypass grafting

Background: This study aims to evaluate the effect of L-carnitine on postoperative cardiac performance and morbidity and complications in patients undergoing coronary artery bypass grafting.Methods: Between April 2005 and June 2008, a total of 60 patients (36 males, 24 females; mean age 60.6 years; range 57 to 65) who were scheduled for coronary artery bypass grafting were prospectively randomized to receive one of three different strategies of myocardial preservation. Group A (n=20) received antegrade crystalloid cardioplegia, Group B (n=20) received antegrade blood cardioplegia, and Group C (n=20) received antegrade blood cardioplegia with carnitine. Samples for lactate dehydrogenase (LDH), creatinine phosphokinase (CPK), creatinine phosphokinasemyocardial band (CK-MB), and Troponin-I were taken from coronary sinus during the operation and from peripheral venous line postoperatively. Blood samples were obtained before CPB, just after CPB and postoperative 1, 6, 12, 24 and 48 hours. Levels of CPK, CK-MB and Troponin-T levels were studied by immunoassay method.Results: The patients who received carnitine had significantly improved cardiac output, cardiac index, and right and left ventricular stroke work immediately after cardiopulmonary bypass and at the first postoperative hour (p=0.01). Troponin-T levels decreased in all patients after 12 hours postoperatively, andthis change was most prominent in Group C (p=0.001). Conclusion: Intravenous supplementation of carnitine duringcardioplegia provides better results on the recovery of cardiac function and metabolic parameters after coronary artery bypass grafting.

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22. Broderick TL, Quinney HA, Barker CC, Lopaschuk GD. Beneficial effect of carnitine on mechanical recovery of rat hearts reperfused after a transient period of global ischemia is accompanied by a stimulation of glucose oxidation. Circulation 1993;87:972-81.
21. Reznick AZ, Kagan VE, Ramsey R, Tsuchiya M, Khwaja S, Serbinova EA, et al. Antiradical effects in L-propionyl carnitine protection of the heart against ischemia-reperfusion injury: the possible role of iron chelation. Arch Biochem Biophys 1992;296:394-401.
20. Packer L, Valenza M, Serbinova E, Starke-Reed P, Frost K, Kagan V. Free radical scavenging is involved in the protective effect of L-propionyl-carnitine against ischemia-reperfusion injury of the heart. Arch Biochem Biophys 1991;288:533-7.
19. Gunes T, Bozok S, Kestelli M, Yurekli I, Ilhan G, Ozpak B, et al. -tocopherol and ascorbic acid in early postoperative period of cardiopulmonary bypass. J Cardiovasc Med (Hagerstown) 2012;13:691-9.
18. Gonca E, Barut F, Erdem S. Cardioprotective effect of zileuton: a 5-lipoxygenase inhibitor against myocardial ischemia/ reperfusion injury. Turk Gogus Kalp Dama 2017;25:273-81.
17. Sarac A, Akar H, Yildiz L, Kolbakir F, Keçeligil HT, Yıldız L. Comparison of effects of carnitine and ascorbic acid on reperfusion injury. Turk Gogus Kalp Dama 2000;8:520-4.
16. Keller VA, Toporoff B, Raziano RM, Pigott JD, Mills NL. Carnitine supplementation improves myocardial function in hearts from ischemic diabetic and euglycemic rats. Ann Thorac Surg 1998;66:1600-3.
15. Lango R, Smolenski RT, Narkiewicz M, Suchorzewska J, Lysiak-Szydlowska W. Influence of L-carnitine and its derivatives on myocardial metabolism and function in ischemic heart disease and during cardiopulmonary bypass. Cardiovasc Res 2001;51:21-9.
14. Boyle EM Jr, Pohlman TH, Cornejo CJ, Verrier ED. Endothelial cell injury in cardiovascular surgery: ischemia-reperfusion. Ann Thorac Surg 1996;62:1868-75.
13. Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982;66:1146-9.
12. Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982;66:1146-9.
11. Lichtenstein SV, el Dalati H, Panos A, Slutsky AS. Long cross-clamp time with warm heart surgery. Lancet 1989;1:1443.
10. Sakamoto T, Aoki M, Imai Y, Nemoto S. Carnitine affects fatty acid metabolism after cardioplegic arrest in neonatal rabbit hearts. Ann Thorac Surg 2001;71:648-53.
9. Nemoto S, Yasuhara K, Nakamura K, Miyoshi Y, Sakai A. Plasma carnitine concentrations in patients undergoing open heart surgery. Ann Thorac Cardiovasc Surg 2004;10:19-22.
8. Mingorance C, Rodriguez-Rodriguez R, Justo ML, Herrera MD, de Sotomayor MA. Pharmacological effects and clinical applications of propionyl-L-carnitine. Nutr Rev 2011;69:279-90.
7. Sethi R, Wang X, Ferrari R, Dhalla NS. Improvement of cardiac function and beta-adrenergic signal transduction by propionyl L-carnitine in congestive heart failure due to myocardial infarction. Coron Artery Dis 2004;15:65-71.
6. Böhles H, Noppeney T, Akcetin Z, Rein J, von der Emde J. The effect of preoperative L-carnitine supplementation on myocardial metabolism during aorto-coronary bypass surgery. Z Kardiol 1987;76:14-8.
5. Iliceto S, Scrutinio D, Bruzzi P, D'Ambrosio G, Boni L, Di Biase M, et al. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial. J Am Coll Cardiol 1995;26:380-7.
4. Ferrari R, Merli E, Cicchitelli G, Mele D, Fucili A, Ceconi C. Therapeutic effects of L-carnitine and propionyl-L-carnitine on cardiovascular diseases: a review. Ann N Y Acad Sci 2004;1033:79-91.
3. Demeyere R, Lormans P, Weidler B, Minten J, Van Aken H, Flameng W. Cardioprotective effects of carnitine in extensive aortocoronary bypass grafting: a double-blind, randomized, placebo-controlled clinical trial. Anesth Analg 1990;71:520-8.
2. Hazan E, Uğurlu B, Metin K, Saydam N, Silistireli E, Sarıosmanoğlu N, et al. The effects of L Carnitine as an additive in cardioplegic solutions for myocardial protection. Turk Gogus Kalp Dama 2002;10:131-4.
1. Pastoris O, Dossena M, Foppa P, Catapano M, Arbustini E, Bellini O, et al. Effect of L-carnitine on myocardial metabolism: results of a balanced, placebo-controlled, double-blind study in patients undergoing open heart surgery. Pharmacol Res 1998;37:115-22.