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

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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.

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Authors and Affiliations

  1. Department for Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Nikola Lakič MD

  2. Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia

    Miha Mrak MD, Miha Šušteršič MD, Peter Rakovec MD PhD &  Matjaž Bunc MD PhD

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  1. Nikola Lakič MD
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  2. Miha Mrak MD
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  3. Miha Šušteršič MD
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  4. Peter Rakovec MD PhD
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  5. Matjaž Bunc MD PhD
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Corresponding author

Correspondence to Matjaž Bunc MD PhD.

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Conflict of interest

N. Lakič, M. Mrak, M. Šušteršič, P. Rakovec, and M. Bunc declare that they have no competing interests.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its current revised form). Informed consent was obtained from all patients included in the study.

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Lakič, N., Mrak, M., Šušteršič, M. et al. Perioperative erythropoietin protects the CNS against ischemic lesions in patients after open heart surgery. Wien Klin Wochenschr 128, 875–881 (2016). https://doi.org/10.1007/s00508-016-1063-0

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  • DOI: https://doi.org/10.1007/s00508-016-1063-0

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