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A preliminary study about the effects of warm priming solution on oxidative stress and postoperative atrial fibrillation in open heart surgery

Eine präliminäre Studie über die Wirkungen von warmen vorbereitenden Lösungen auf den oxidativen Stress und postoperatives Vorhofflimmern in der Chirurgie am offenen Herzen

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Summary

Background

An important reason for production of ischemia and reperfusion injury and oxidative stress is the sudden and rapid changes in body temperature during the institution of cardiopulmonary bypass. The aim of this study was to investigate the effects of warm priming solution on oxidative stress and atrial fibrillation.

Methods

This is a preliminary prospective study on a group of 40 patients who underwent elective coronary artery bypass grafting operation using cardiopulmonary bypass. Patients were randomized into two groups, each consisting of 20 patients; one group was primed with a solution at 20 °C and the other at 36 °C initially for cardiopulmonary bypass. Blood samples from both of the groups were drawn preoperatively and at the 15th and 60th min of aortic cross clamping and 24th h following the surgery. Serum malondialdehyde levels, protein carbonyl content and total antioxidant status were detected. Patients were followed for postoperative atrial fibrillation.

Results

Malondialdehyde and protein carbonyl content were found to be significantly higher and total antioxidant status was concordantly lower in the cold priming group at the 15th and 60th min, recovering to the normal range postoperatively at the 24th h. Patients in the cold priming group had developed a significantly higher rate of atrial fibrillation when compared with the patients in the warm priming group during the postoperative period.

Conclusion

In conclusion, although this study has its limitation about the sample size it may provide an insight about the probable preventive effects of 36 °C warm priming solution in oxidative stress and postoperative atrial fibrillation.

Zusammenfassung

Grundlagen

Ein wichtiger Grund für die Entstehung einer Ischämie, eines Reperfusionsschadens und von oxidativem Stress ist die plötzliche und rasche Änderung der Körpertemperatur während der Einleitung eines kardiopulmonalen Bypasses. Ziel unserer Studie ist es, die Wirkungen von warmen vorbereitenden Lösungen auf oxidativen Stress und Vorhofflimmern zu untersuchen.

Methodik

Es handelt sich um eine präliminäre, prospektive Studie an 40 Patienten, die einer elektiven Koronararterien-Bypass-Operation mit kardiopulmonalem Bypass unterzogen wurden. Die Patienten wurden in 2 Gruppen von jeweils 20 randomisiert: die eine wurde anfangs mit einer 20 °C Lösung, die andere mit einer 36 °C Lösung für den kardiopulmonalen Bypass vorbereitet. Präoperativ und in der 15. und in der 60. Min nach der Aortenklemmung, sowie 24 h postoperativ wurden von beiden Gruppen Blutproben abgenommen. Die Serumkonzentrationen von Malondialdehyd, sowie der Karbonyl-Protein-Gehalt und der gesamte antioxidative Status wurden bestimmt. Das Auftreten von postoperativem Vorhofflimmern wurde kontrolliert.

Ergebnisse

Malondialdehyd-Konzentrationen und der Karbonyl-Protein-Gehalt waren in der 15. und 60. Min bei den Patienten mit kalter Vorbereitung signifikant höher. Zugleich war der Gesamt-antioxidative Status signifikant erniedrigt. Diese Veränderungen normalisierten sich bis zur 24 h postoperativ. Bei den Patienten mit der kalten Vorbereitung trat Vorhofflimmern in der postoperativen Phase signifikant häufiger als bei den Patienten mit der körperwarmen Vorbereitung auf.

Schlussfolgerung

Obwohl die Studie nur an relativ wenigen Patienten durchgeführt wurde, könnte sie doch einen Hinweis auf mögliche präventive Wirkungen einer 36 °C warmen vorbereitenden Lösung im Bezug auf die Entstehung von oxidativen Stress und postoperativem Vorhofflimmern geben.

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Conflict of interest

The authors declare that there is no source of funding for the work.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, School of Medicine, Zonguldak Karaelmas University, 67600, Kozlu-Zonguldak, Turkey

    Mustafa Buyukates MD &  Ozer Kandemir MD

  2. Department of Clinical Biochemistry, School of Medicine, Zonguldak Karaelmas University, Kozlu-Zonguldak, Turkey

    Serefden Acikgoz MD

  3. Department of Family Medicine, School of Medicine, Zonguldak Karaelmas University, Kozlu-Zonguldak, Turkey

    Erol Aktunc MD

  4. Department of Cardiology, School of Medicine, Zonguldak Karaelmas University, Kozlu-Zonguldak, Turkey

    Sait Mesut Dogan MD &  Mustafa Aydin MD

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  1. Mustafa Buyukates MD
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  2. Serefden Acikgoz MD
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  4. Ozer Kandemir MD
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  6. Mustafa Aydin MD
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Correspondence to Mustafa Buyukates MD.

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Buyukates, M., Acikgoz, S., Aktunc, E. et al. A preliminary study about the effects of warm priming solution on oxidative stress and postoperative atrial fibrillation in open heart surgery. Wien Klin Wochenschr 124, 618–623 (2012). https://doi.org/10.1007/s00508-012-0222-1

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  • DOI: https://doi.org/10.1007/s00508-012-0222-1

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