Complex evaluation of endothelial dysfuncion markers for prediction of outcomes in coronary surgery.

Abstract

Objective: to evaluate the dynamics of endothelial dysfunction markers during coronary artery bypass grafting (CABG) and to estimate their significance as predictors of postoperative complications in coronary surgery. Methods. The study included 30 patients scheduled for coronary artery bypass surgery (CABG) with cardiopulmonary bypass. We determined the concentration of endothelial dysfunction markers is blood plasma, including endothelin-1 (ET-1) and nitric oxide metabolites: total content (NOx.total), nitrite (NO2-) and nitrate (NO3-) before the surgery, at the end of the surgery and 24 hours postoperatively. Results. 5 patients (16,7%) demonstrated the complicated course of postoperative period (group I). In this group there was a significantly higher level of ET-1 in all three control points: before the surgery, at the end of the surgery and 24 hours postoperatively (p = 0,012; p = 0,010; p = 0,015) comparing to group II (uncomplicated course). Concentration of NO3- at the end of the surgery was substantially lower than in group II - 3,98 (1,96-5,82) and 10,53 (7,39-14,15) µmol/l, accordingly (p = 0,041). Concentration of NO2- before the surgery was about the same in both groups, but at the end of the surgery concentration of NO2- was significantly lower in group I comparing to group II - 0,34 (0,18-0,53) and 1,12 (0,85-1,40) µmol/l, accordingly, p = 0,001. Conclusion. High level of ET-1 at all stages of the surgery, as well as decline of NO2- and NO3- levels by the end of the surgery may be regarded as predictors of complicated course of postoperative period in CABG patients. Overproduction of ET-1 and imbalance of NO production during CABG may facilitate microcirculatory dysfunction and multiple organ failure.