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J Thorac Cardiovasc Surg 1996;111:29-35
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

ATTENUATION OF CARDIOPULMONARY BYPASS–DERIVED INFLAMMATORY REACTIONS REDUCES MYOCARDIAL REPERFUSION INJURY IN CARDIAC OPERATIONS

Osaka, Japan

From the First Department of Surgery, Osaka University Medical School, Osaka, Japan.

Received for publication Dec. 22, 1994. Accepted for publication March 17, 1995. Address for reprints: Hikaru Matsuda, MD, First Department of Surgery, Osaka University Medical School, 2-2 Yamada-oka, Suita, Osaka 565, Japan.

Abstract

In cardiac operations endopeptidase (protease) inhibitor may be beneficial in reducing myocardial injury when administered in the cardiopulmonary bypass prime. Nafamostat mesilate was evaluated in 20 patients who underwent coronary artery bypass grafting. The patients were divided into a control group (n = 10) and a nafamostat group (n = 10). Nafamostat (2 mg/kg per hour) was continuously given during cardiopulmonary bypass in the nafamostat group. The age, number of grafts, cardiopulmonary bypass time, and aortic crossclamp time were similar between groups. In the control group, neither tumor necrosis factor-nor interleukin-1 levels showed any significant change during cardiopulmonary bypass, whereas interleukin-6 and interleukin-8 levels, percent expression of adhesion molecule (CD18) on neutrophils, and CH₅₀ assay results increased significantly during cardiopulmonary bypass. As compared with the control group, the nafamostat group showed significantly lower levels of interleukin-6 (123 ± 57 versus 40 ± 22 pg/ml, respectively) and interleukin-8 (96 ± 13 versus 66 ± 14 pg/ml, respectively). The nafamostat group showed a significantly lower difference of CH₅₀ assay results and malondialdehyde levels between coronary sinus blood and arterial blood and peak values of creatine kinase MB (43 ± 12 IU/L versus 19 ± 6 IU/L) during the postoperative course compared with findings in the control group. These results demonstrated that inflammatory reactions induced by cardiopulmonary bypass had adverse effects on myocardial recovery after aortic crossclamping and that nafamostat mesilate given during cardiopulmonary bypass appeared to reduce myocardial reperfusion injury by attenuating such inflammatory reactions. Attenuation of inflammatory reactions of cardiopulmonary bypass should be considered in the strategy of myocardial protection. (J THORAC CARDIOVASC SURG 1996;111:29-35)

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