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Objective: The present study was designed to investigate the cardioprotective effect of exogenous administration of bradykinin (BK) in cardiac surgery., Methods: Forty-one patients who were scheduled for isolated coronary artery bypass grafting (CABG) were randomized into Control group and BK group. BK patients received 25 microg bradykinin infusion for 7 minutes before the cardiopulmonary bypass (CPB). Release of cardiac specific troponin I (TnI) and creatine kinase cardiac isoenzyme (CK-MB) was recorded. Perioperative circulating cytokine interleukin (IL)-6, 8 and 10 were measured., Results: There was no significant difference in TnI between groups. However, BK patients released significantly less CK-MB than the controls (p =0.043). Systemic plasma levels of IL-6, IL-8 and IL-10 increased significantly after reperfusion in both groups as compared with baseline (p <0.05). The ratio of IL-8 to IL-10 was significantly lower in BK groups than in controls (p =0.03)., Conclusions: We conclude that exogenous administration of BK prior to CPB in CABG patients attenuates ischemic myocardial injury. It also shifts the circulating inflammatory cytokine balance towards the anti-inflammatory direction.

Objectives: Factors leading to the occlusion of coronary grafts are diverse and may at least partially be inherited. We aimed to study the possible genetic predisposition and especially the role of apoE epsilon4 allele as a risk factor for repeated coronary artery bypass grafting (CABG) in a case-control setting., Design: All patients (n=184) who underwent repeated CABG between 1990 and 1998 were identified in the computed registry of the Department of Cardiothoracic Surgery in Tampere University Hospital. Age, sex and operation date matched controls with first time CABG were selected from the same registry. DNA samples were collected by sample stick sent via the mail for buccal smear. The final analysis included 137 surviving matched pairs., Results: In patients <62 years of age (median age), family history emerged as the only significant (OR=3.4; 95% CI=1.5-7.8, p=0.004) predictor for repeated surgery. Among older patients, repeated CABG was no longer predicted by family history but by hypercholesterolemia (OR=2.1; 95% CI=1.1-4.0, p=0.027), modified by apoE genotype., Conclusions: Our results suggest that medium-term survivors after redo CABG have a strong genetic predisposition unrelated to hypercholesterolemia or apoE genotype, leading to more severe coronary artery disease at earlier age. In the older age group, redo coronary artery bypass surgery is associated with hypercholesterolemia, which, although modified by apoE genotype, may mainly be due to other genetic or acquired factors.

Objective: Cardiovascular risk factor profile of patients in need of repeated coronary artery bypass surgery (redo CABG) seldom differ from patients having only single coronary artery bypass surgery (CABG). The aim of this study was to analyse the influence of positive family history for coronary artery disease in respect to redo CABG vs CABG in a case-control setting., Design: One hundred and eighty four patients undergoing redo CABG between 1990-1998 were identified from the computed registry of the Department of Cardiothoracic Surgery in Tampere University Hospital. One hundred and eighty four age, gender and operation date matched patients with CABG were selected for control., Results: According to chi-square analysis, positive family history for coronary artery disease was more common in Study group, 60.4% versus 49.5% (p<0.05). Preoperative systolic blood pressure was 135.5+/-1.4 mmHg versus 133.5+/-1.5 mmHg (ns), preoperative diastolic blood pressure was 81.2+/-0.8 mmHg versus 82.8+/-0.9 mmHg (ns), serum total cholesterol was 5.8+/-0.1 mmol/L versus 6.6+/-1.2 mmol/L and preoperative blood glucose was 5.6+/-0.2 mmol/L versus 5.3+/-0.2 mmol/L (ns) in Controls and Study group, respectively. However, serum triglyceride level was significantly higher in Study group 2.8+/-0.2 mmol/L versus 2.0+/-0.1 mmol/L (p<0.000). In regression analysis, only positive family history (OR=2.4; 95% CI=1.1-5.1; p<0,02) and high serum triglyceride level (>or=2 mmol/L, OR=1.6; 95% CI=1.2-2.2; p<0,02) were independent predictors for redo CABG., Conclusion: According to this study, positive family history for coronary atherosclerosis at the presence of high serum triglyceride level is significantly predicting the need for future redo CABG as compared with age, gender and operation time matched controls of CABG.

Objective: To investigate whether administration of isoflurane prior to cardiopulmonary bypass (CPB) could partly account for the observed protection of the myocardial function and to decrease myocardial injury in patients undergoing coronary artery bypass grafting (CABG)., Methods: Thirty-four patients with stable angina who were scheduled for isolated elective CABG operations were randomized into the control group or isoflurane (ISO) group. In the ISO group, isoflurane was inhaled for 5 min followed by another 5-min washout period before commencing CPB. The control group did not receive isoflurane. Hemodynamic data and biochemical markers of myocardial injury were measured perioperatively., Results: There were no adverse effects related to isoflurane. Cardiac index (CI) increased postoperatively as compared with the baseline. In the ISO group, there was a tendency for a greater increase of CI than that in the control group (p = 0.054, ANOVA for repeated measurements). At 1 h after CPB, the change of CI was much higher in the ISO group than that in the controls (p = 0.001). Both the creatine kinase cardiac isoenzyme (CK-MB) and troponin I (TnI) reached peak value at 6 h after CPB. Isoflurane patients released slightly less CK-MB than the controls postoperatively, but the difference was not significant (p = 0.16, ANOVA for repeated measurements). The release of TnI was similar in both groups (p = 0.65, ANOVA for repeated measurements)., Conclusions: Administration of isoflurane prior to commencing CPB may bring an improvement in early hemodynamic performance after CABG operations.

Objective: The purpose of the present study was to establish whether pump prime aprotinin could influence soluble adhesion molecules in patients undergoing elective coronary artery bypass surgery., Design: Thirty patients admitted for first-time elective coronary artery bypass surgery were randomized into control or aprotinin groups. Patients in the aprotinin group received 280 mg of aprotinin in the pump prime. Plasma levels of soluble adhesion molecules were analyzed perioperatively., Results: There were no significant changes in plasma sE-selectin after the operation in either group. Plasma sP-selectin increased significantly up to 20 h after reperfusion to the myocardium. Plasma sICAM-1 decreased in the early stage after cardiopulmonary bypass (CPB), then recovered at 4 h after reperfusion and a significant increase in sICAM-1 was observed 20 h later. There were no significant differences between the groups in postoperative changes in sP-selectin (p = 0.21) and sICAM-1 (p = 0.91)., Conclusion: Pump prime aprotinin did not influence plasma levels of E-selectin, P-selectin and ICAM-1 in the present patients. The present results do not support the concept of an anti-inflammatory effect of pump prime aprotinin.

Objective: To evaluate cast models in the imaging of experimental end-to-side anastomoses., Design: Experimental study., Setting: Teaching hospital, Finland., Interventions: 20 non-stenosed and 10 stenosed end-to-side anastomoses were constructed using a Dacron prosthesis 8 mm in diameter. Cast models were made of all anastomoses, and anteroposterior and oblique projection radiographs were taken of them. Cross-sectional radiographs were also taken of the stenosed anastomoses., Main Outcome Measurements: The diameters and areas of anastomoses were measured on the radiographs and compared with the corresponding measurements of the casts., Results: No filling defects were observed in any of the cast models and only minor differences were found between the corresponding measurements of the anteroposterior and oblique projection radiographs and casts. The lower density of the contrast medium in the stenotic anastomoses indicated a stenosis. In the cross-sectional radiographs of the stenotic anastomoses there was a significant reduction (p < 0.001) both in the diameter and the area, the mean of which was 63% and the median 61%., Conclusions: Radiographs of cast models look promising in imaging of experimental end-to-side anastomoses when cross-sectional projections are also used.

Objective: The release of proinflammatory cytokines has been shown to be associated with the development of complications after coronary artery bypass grafting with cardiopulmonary bypass. The purpose of the present study was to establish whether ischemic preconditioning (IP) could limit inflammatory cytokines release in patients undergoing elective coronary artery bypass surgery., Methods: Twenty-two patients with multiple-vessel coronary artery disease and stable angina admitted for first-time elective coronary artery bypass surgery were randomized into control or ischemic preconditioning groups. Patients in the IP group were exposed to two cycles of two-minute myocardial ischemia, followed by three minutes of reperfusion, at the beginning of the revascularization operation, before the cross-clamping and ischemic period used for coronary artery bypass graft anastomosis. Peripheral plasma levels of TNF-alpha, IL-6, IL-8 and IL-10 were measured perioperatively., Results: Significant elevation of IL-6, IL-8 and IL-10 were observed in both groups after reperfusion. Ischemic preconditioning has no effect on cytokine release in the early stage after reperfusion. Arterial blood IL-6 levels in the preconditioning group were significantly lower than in controls at 20 h after declamping (52.93 +/- 9.79 vs 96.04 +/- 17.56 pg/ml, p < 0.05)., Conclusions: The results indicate that ischemic preconditioning results in no effect on systemic inflammatory cytokine release in the early stage but a delayed reduction in IL-6 levels at 20 h after reperfusion.

Background: The purpose of this study was to establish whether pump prime aprotinin could limit the cytokine responses in patients undergoing elective coronary artery bypass surgery., Methods: Twenty-one patients admitted for first-time elective coronary artery bypass surgery were randomized into control or aprotinin groups. Patients in the aprotinin group received 280 mg aprotinin in the pump prime. Leukocyte count, creatine kinase cardiac isoenzyme (CK-MB), cytokine production and postoperative blood loss were analyzed perioperatively and compared with preoperative values., Results: The peak level of leukocyte count was lower in the aprotinin group than in controls (9.3 +/- 0.58 vs 11.2 +/- 0.68 x 10(9)/L, p = 0.01). Interleukin (IL)-6 and IL-8 did not differ significantly between the groups throughout the study period. Plasma IL-10 levels were higher in the controls than in the aprotinin group at 5 min (49.6 +/- 24.9 vs 8.13 +/- 2.8 pg/ml, p = 0.01) after reperfusion., Conclusion: Pump prime aprotinin fails to limit proinflammatory cytokine response in circulating blood.

Objective: To find out if the C-reactive protein (CRP) concentration and the white cell count (WCC) are of any prognostic value in patients with acute extremity ischaemia., Design: Retrospective study., Setting: Tampere University Hospital and Jyväskylä Central Hospital, Finland., Subjects: 129 patients with acute extremity ischaemia., Main Outcome Measures: Preoperative CRP concentration, white cell count, packed cell volume, serum creatinine concentration, major amputation and death., Results: The median (range) CRP concentration was 50.0 (3-271) mg/l in the 28 patients who underwent major amputation or died (group 1) and 11.0 (1.175) mg/l in the 65 patients who survived with viable limbs (group 2) (p = 0.007). The median (range) WCC was 13.1 (5.9-42.0) x 10(9)/l in group 1 (30 patients) and 9.5 (2.2-23.9) x 10(9)/l in group 2 (79 patients) (p < 0.001). The cut-off point of 20 mg/l for CRP and 11.0 x 10(9)/l for WCC had negative predictive values of 0.83 and 0.85 for amputation and mortality, respectively., Conclusion: Preoperative CRP concentration and WCC correlated with limb salvage and mortality in patients with acute extremity ischaemia.