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Wiener klinische Wochenschrift

Erschienen in:

01.12.2016 | original article

Perioperative erythropoietin protects the CNS against ischemic lesions in patients after open heart surgery

verfasst von: Nikola Lakič, MD, Miha Mrak, MD, Miha Šušteršič, MD, Peter Rakovec, MD PhD, Prof. Matjaž Bunc, MD PhD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 23-24/2016

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Summary

Aim

The aim of this study was to establish erythropoietin as a protective factor against brain ischemia during open heart surgery.

Methods

A total of 36 consecutive patients scheduled for revascularization heart surgery were included in the study. Of the patients 18 received 3 intravenous doses of recombinant human erythropoietin (rHuEpo, 24,000 IU) and 18 patients received a placebo. Magnetic resonance imaging (MRI) to detect new brain ischemic lesions was performed. Additionally, S100A, S100B, neuron-specific enolase A and B (NSE-A and B) and the concentration of antibodies against N‑methyl-D-aspartate receptors (NMDAR) to identify new neurological complications were determined.

Results

Patients who received rHuEpo showed no postoperative ischemic changes in the brain on MRI images. In the control group 5 (27.8 %) new ischemic lesions were found. The NMDAR antibody concentration, S100A, S100B and NSE showed no significant differences between the groups for new cerebral ischemia. High levels of lactate before and after external aortic compression (p = 0.022 and p = 0.048, respectively) and duration of operation could predict new ischemic lesions (p = 0.009).

Conclusions

The addition of rHuEpo reduced the formation of lesions detectable by MRI in the brain and could be used clinically as neuroprotection in cardiac surgery.

Vorheriger Artikel Orosomucoid is an independent predictor of prognosis in chronic heart failure

Nächster Artikel Evaluation of the pharmacoDYNAMIC effects of riociguat in subjects with pulmonary hypertension and heart failure with preserved ejection fraction

Hogue CW, Murphy SF, Schechtman KB, et al. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100:642–7.CrossRefPubMed

Hogue CW, Barzilai B, Pieper KS, et al. Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report. Circulation. 2001;103:2133–7.CrossRefPubMed

Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. N Engl J Med. 2001;344:395–402.CrossRefPubMed

Arrowsmith JE, Grocott HP, Reves JG, et al. Central nervous system complications of cardiac surgery. Br J Anaesth. 2000;84:378–93.CrossRefPubMed

Van Dijk D, Keizer AM, Diephuis JC, et al. Neurocognitive dysfunction after coronary artery bypass surgery: a systematic review. J Thorac Cardiovasc Surg. 2000;120:632–9.CrossRefPubMed

Shroyer AL, Coombs LP, Peterson ED, et al. 30-day operative mortality and morbidity risk models. Ann Thorac Surg. 2003;75:1856–64.CrossRefPubMed

Ehrenreich H, Weissenborn K, Prange H, et al. Recombinant human erythropoietin in the treatment ofacute ischemic stroke. Stroke. 2009;40:647–56.CrossRef

Ehrenreich H, Timner W, Sirén AL. A novel role for an established player: anemia drug erythropoietin for the treatment of cerebral hypoxia/ischemia. Transfus Apher Sci. 2004;31:39–44.CrossRefPubMed

Mahanna EP, Blumenthal JA, White WD, et al. Defining neuropsychological dysfunction after coronary artery bypass grafting. Ann Thorac Surg. 1996;61:1342–7.CrossRefPubMed

10.

Jönsson H, Johnsson P, Alling C, et al. S100beta after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome. Ann Thorac Surg. 1999;68:2202–8.CrossRefPubMed

11.

Herrmann M, Ebert AD, Galazky I, et al. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke. 2000;31:645–50.CrossRefPubMed

12.

Donato R. Functional roles of S100 proteins, calcium-binding proteinsof the EF-hand type. Biochim Biophys Acta. 1999;1450:191–231.CrossRefPubMed

13.

Hogue CW Jr, Palin CA, Arrowsmith JE. Cardiopulmonary bypass management and neurologicoutcomes: an evidence-based appraisal of current practices. Anesth Analg. 2006;103:21–37.CrossRefPubMed

14.

Ehrenreich H, Hasselblatt M, Dembowski C, et al. Erythropoietin therapy for acute stroke is both safe and beneficial. Mol Med. 2002;8(8):495–505.PubMedPubMedCentral

15.

Ehrenreich H, Degner D, Meller J, et al. Erythropoietin: a candidate compound for neuroprotection in schizophrenia. Mol Psychiatry. 2004;9:42–54.PubMed

16.

Lacombe C, Mayeux P. The molecular biology of erythropoietin. Nephrol Dial Transplant. 1999;14:22–8.CrossRefPubMed

17.

Lipsic E, Schoemaker RG, van der Meer P, et al. Protective effects of erythropoietin in cardiac ischemia: from bench to bedside. J Am Coll Cardiol. 2006;48:2161–7.CrossRefPubMed

18.

Parsa CJ, Matsumoto A, Kim J, et al. A novel protective effect of erythropoietin in the infarcted heart. J Clin Invest. 2003;112:999–1007.CrossRefPubMedPubMedCentral

19.

Miskowiak K, O’Sullivan U, Harmer CJ. Erythropoietin reduces neural and cognitive processing of fear in human models of antidepressant drug action. Biol Psychiatry. 2007;62:1244–50.CrossRefPubMed

20.

Nagpal AD, Bhatnagar G, Cutrara CA, et al. Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians. Can J Cardiol. 2006;22:849–53.CrossRefPubMedPubMedCentral

21.

Zanatta P, Forti A, Minniti G, et al. Brain emboli distribution and differentiation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2013;27(5):865–75. doi:10.1053/j.jvca.2012.12.022.CrossRefPubMed

22.

Douglas JM, Spaniol SE. A multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery. Am J Surg. 2009;197:587–90.CrossRefPubMed

23.

Masabni K, Raza S, Blackstone EH, et al. Does preoperative carotid stenosis screening reduce perioperative stroke in patients undergoing coronary artery bypass grafting? J Thorac Cardiovasc Surg. 2015;149(5):1253–60.CrossRefPubMedPubMedCentral

24.

Lee EJ, Choi KH, Ryu JS, et al. Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis. J Am Coll Cardiol. 2011;57:1811–8.CrossRefPubMed

25.

Gottesman RF, Sherman PM, Grega MA. Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome. Stroke. 2006;37:2306–11.CrossRefPubMed

26.

Lakic N, Surlan K, Jerin A, et al. Importance of erythropoietin in brain protection aftercardiac surgery: a pilot study. Heart Surg Forum. 2010;13:185–9.CrossRef

27.

Lipsic E, Westenbrink BD, van der Meer P, et al. Erythropoietin induces neovascularisation and improves cardiac function in rats with heart failure after myocardial infarction. J Am Coll Cardiol. 2005;46(1):125–33.CrossRefPubMed

28.

Sakanaka M, Wen TC, Matsuda S, et al. Invivo evidence that erythropoietin protects neurons fromischemic damage. Proc Natl Acad Sci USA. 1998;95:4635–40.CrossRefPubMedPubMedCentral

29.

Junk AK, Mammis A, Savitz SI, et al. Erythropoietin administration protects retinal neurons fromacute ischemia-reperfusion injury. Proc Natl Acad Sci USA. 2002;99:10659–64.CrossRefPubMedPubMedCentral

30.

Bokesch PM, Izykenova GA, Justice JB, et al. NMDA receptor antibodies predict adverse neurological outcome after cardiac surgery in high-risk patients. Stroke. 2006;37:1432–6.CrossRefPubMed

31.

Stolz E, Gerriets T, Kluge A, et al. Diffusion-weighted magnetic resonance imaging and neurobiochemical markers after aortic valve replacement: implication for future neuroprotective trials? Stroke. 2004;35:888–92.CrossRefPubMed

32.

Dambinova SA, Khounteev GA, Izykenova GA, et al. Blood test detecting autoantibodies to N‑methyl-D-aspartate neuroreceptors for evaluation of patients with transient ischemic attack and stroke. Clin Chem. 2003;49:1752–62.CrossRefPubMed

Titel: Perioperative erythropoietin protects the CNS against ischemic lesions in patients after open heart surgery
verfasst von: Nikola Lakič, MD
Miha Mrak, MD
Miha Šušteršič, MD
Peter Rakovec, MD PhD
Prof. Matjaž Bunc, MD PhD
Publikationsdatum: 01.12.2016
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift / Ausgabe 23-24/2016
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI: https://doi.org/10.1007/s00508-016-1063-0

Springer Medizin Österreich

Summary

Aim

Methods

Results

Conclusions

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