ABSTRACT
Abstract Objetive: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) improved symptoms and increased survival and quality of life in patients with coronary artery disease. However, it should be the main cause of a complex organic systemic inflammatory response that greatly contributes to several postoperative adverse effects. Methods: We aimed to evaluate heat-shock protein 70 (HSP 70) expression as a morbimortality predictor in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to determine their association with the lactate as a marker of tissue hypoperfusion and the EuroSCORE risk score. This is a prospective, observational study including 46 patients and occurring between May and July 2016. Patients without ventricular dysfunction undergoing myocardial revascularization with extracorporeal circulation were included. They were divided into (1) complicated and (2) uncomplicated postoperative evolution groups. EuroSCORE, lactate levels, and HSP 70 expression and their correlations were determined. Results: Statistical analysis showed that the group with complicated evolution had higher EuroSCORE values than the other group. HSP 70 protein levels were significantly increased in the group with uncomplicated evolution and showed similar results. According to our results, HSP family proteins may be independent predictors of uncomplicated evolution in patients without ventricular dysfunction undergoing CABG with CPB. Conclusion: HSP 70 should be a good discriminator and protection marker for complications in cardiac surgery.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cardiopulmonary Bypass/mortality , Coronary Artery Bypass/mortality , Risk Assessment/methods , HSP70 Heat-Shock Proteins/analysis , Lactic Acid/blood , Preoperative Period , Postoperative Complications/etiology , Biomarkers/analysis , Cardiopulmonary Bypass/methods , Logistic Models , Blotting, Western , Coronary Artery Bypass/methods , Sensitivity and Specificity , Statistics, Nonparametric , Myocardium/pathologyABSTRACT
Abstract The heat shock proteins are endogenous proteins with the ability to act as molecular chaperones. Methods that provide cell protection by way of some damage can positively influence the results of surgery. The present review summarizes current knowledge concerning the cardioprotective role of the heat shock proteins as occurs in heart damage, including relevant information about the stresses that regulate the expression of these proteins and their potential role as biomarkers of heart disease.
Subject(s)
Humans , Myocardial Ischemia/metabolism , Myocytes, Cardiac/physiology , Cardiac Surgical Procedures , Heat-Shock Proteins/physiology , Biomarkers/metabolism , Heat-Shock Proteins/analysis , Myocardium/metabolism , Myocardium/chemistryABSTRACT
OBJETIVO: Comparar os resultados imediatos da cirurgia de revascularização do miocárdio com e sem circulação extracorpórea (CEC). MÉTODOS: De janeiro de 2007 a janeiro de 2009, 177 pacientes foram submetidos a cirurgia de revascularização do miocárdio (CRM), sendo 92, sem CEC e 85 com CEC. Foram avaliados distribuição demográfica, fatores de risco pré-operatórios, classe funcional e avaliação de risco pelo EuroSCORE. A evolução no pós-operatório foi comparada entre os grupos. RESULTADOS: A média de enxertos por paciente foi de 2,48 ± 0,43, no grupo sem CEC, e 2,90 ± 0,59, no com CEC. No grupo sem CEC, 97,8% dos pacientes receberam um enxerto de artéria torácica interna, enquanto que no grupo com CEC a porcentagem foi de 94,1% (P = 0,03). A taxa de revascularização completa foi similar em ambos os grupos. No grupo sem CEC, a artéria circunflexa foi revascularizada em 48,9% dos casos e, em 68,2%, no grupo com CEC (P = 0,01). A mortalidade hospitalar foi de 4,3% e 4,7%, respectivamente, no grupo sem CEC e com CEC (P = 0,92). Os pacientes operados sem CEC apresentaram menor índice de complicações em relação ao infarto perioperatório (P= 0,02) e ao uso de balão intra-aórtico (P= 0,01). CONCLUSÃO: A cirurgia coronariana sem CEC é um procedimento seguro, com mortalidade hospitalar similar a dos pacientes operados com CEC, com menores taxas de complicações e de incidência de infarto perioperatório, bem como menor necessidade de balão intra-aórtico.
OBJECTIVE: The objective of this study is to compare the immediate results of patients undergoing on-pump versus off-pump coronary artery bypass graft (CABG) surgery. METHODS: From January 2007 to January 2009, 177 patients underwent CABG, being 92 off-pump and 85 onpump. We evaluated the demographics, preoperative risk factors, preoperative functional class and risk assessment by the EuroSCORE. The postoperative evolution was compared between groups. RESULTS: The mean number of grafts per patient was 2.48 ± 0.43 in off-pump group and 2.90 ± 0.59 in on-pump group. In the off-pump group, 97.8% of patients received an internal thoracic artery graft, while on-pump group the percentage was 94.1% (P = 0.03). The rate of complete revascularization was similar in both groups. In off-pump group, the circumflex artery was revascularized in 48.9% and 68.2% in the onpump group (P = 0.01). Hospital mortality was 4.3% and 4.7%, respectively in the off-pump group in the on-pump group (P = 0.92). Off-pump group had fewer complications in relation to perioperative myocardial infarction (P = 0.02) and use of intra-aortic balloon pump (P = 0.01). CONCLUSION: The off-pump CABG is a safe procedure with hospital mortality similar to that observed in on-pump CABG, with lower rates of complications and less need for intra-aortic balloon.