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DOI: 10.1055/s-0029-1246888
Circulating endothelial cells – a super-sensitive marker of myocardial cell injury
Objectives: Previously we showed that circulating endothelial cells (CEC) are a sensitive marker for endothelial injury in patients undergoing CABG applying different cardiopulmonary-bypass-setups (CPB). We showed that Calafiore (CAL) cardioplegia has poor cardioprotective properties in patients undergoing cardiac surgical procedures with prolonged aortic cross-clamp times (>80min.) compared to Buckberg (BUCK) cardioplegia. In this study we investigated the cardioprotective characteristics of CAL versus BUCK determined by CEC.
Methods: CECs were quantified by magnetic-bead-isolation from 68 patients who underwent elective CABG. Patients were divided into groups based on the cardioplegia. Samples were obtained preoperatively, 1h and 24h postoperatively. Plasma/serum levels of vonWillebrand factor (vWF), soluble thrombomodulin (sTm), creatin-kinase (CK/CK-MB) and troponinT were measured.
Results: There was no significant difference in demographic data, preoperative risk-profile, CPB-time, no. of bypasses and aortic cross-clamp-time (37±12min. vs. 41±18min., p=0.481). The postoperative course was smooth in both groups with no adverse events. CK/CK-MB and troponinT were increased in CAL at 24h but did not reach significance (967±221/6±3.8% U/l vs. 735±261/4.2±3.2% U/l, p=0.321). However, CECs were significantly elevated in CAL vs. BUCK at 1h with normalization at 24h postoperatively (18.4±4.1 vs. 10.1±3.9, p=0.012). Likewise, the endothelial plasma markers were elevated at 1h (vWF: 258.2±89.7 U/dl vs. 178.4±73.2 U/dl, p=0.001; sTm: 5.2±2.4ng/ml vs. 3.2±2.1ng/ml, p=0.011) but remained elevated during the observation period.
Conclusions: The number of circulating endothelial cells reveals the poor cardioprotective characteristics of Calafiore cardioplegia, which is masked in patients with brief aortic cross-clamptime and may not reach clinical relevance.