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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 Methods Results Conclusions

The aim of this study was to establish erythropoietin as a protective factor against brain ischemia during open heart surgery.
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.
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).
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
Literatur
1.
Hogue CW, Murphy SF, Schechtman KB, et al. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100:642–7.CrossRefPubMed
2.
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
3.
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
4.
Arrowsmith JE, Grocott HP, Reves JG, et al. Central nervous system complications of cardiac surgery. Br J Anaesth. 2000;84:378–93.CrossRefPubMed
5.
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
6.
Shroyer AL, Coombs LP, Peterson ED, et al. 30-day operative mortality and morbidity risk models. Ann Thorac Surg. 2003;75:1856–64.CrossRefPubMed
7.
Ehrenreich H, Weissenborn K, Prange H, et al. Recombinant human erythropoietin in the treatment ofacute ischemic stroke. Stroke. 2009;40:647–56.CrossRef
8.
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
9.
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.
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
Metadaten
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

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