Sivelestat Attenuates Lung Injury in Surgery for Congenital Heart Disease With Pulmonary Hypertension Norikazu Nomura, MD, PhD, Miki Asano, MD, PhD,

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Presentation transcript:

Sivelestat Attenuates Lung Injury in Surgery for Congenital Heart Disease With Pulmonary Hypertension Norikazu Nomura, MD, PhD, Miki Asano, MD, PhD, Takayuki Saito, MD, PhD, Takuya Nakayama, MD, PhD, Akira Mishima, MD, PhD The Annals of Thoracic Surgery Volume 96, Issue 6, Pages 2184-2191 (December 2013) DOI: 10.1016/j.athoracsur.2013.07.017 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Protocol of the study. Timing of sampling of blood is shown. Sivelestat sodium hydrate (0.2 mg/kg/hour) or the same amount of saline was administered from the initiation of CPB until 6 hours after weaning from bypass. (ACC = aortic cross-clamp; CPB = cardiopulmonary bypass; ICU = intensive care unit.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Changes in (A) alveolar-arterial oxygen tension gradient (Aa-Do2) and (B) respiratory index in the 2 groups. Treatment with sivelestat reduced the value of Aa-Do2 at 24 hours after weaning from cardiopulmonary bypass (CPB) (183.78 mmHg ± 121.23 mmHg vs 372.15 mmHg ± 173.94 mmHg, p = 0.038) and at 48 hours after weaning from CPB (93.38 mmHg ± 122.17 mmHg vs 355.16 mmHg ± 219.16 mmHg, p = 0.028). The groups were similar with respect to respiratory index. (*p < 0.05; ● = sivelestat group, n = 7; □ = placebo group, n = 6.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Changes in the balance of hydration in the 2 groups. The balance of hydration at 48 hours after weaning from cardiopulmonary bypass (CPB) in the sivelestat group was significantly better than that in the placebo group (75.2 mL ± 76.2 mL vs 313.9 mL ± 184.4 mL, p = 0.012). (*p < 0.05; ● = sivelestat group, n = 7; □ = placebo group, n = 6.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Changes in the plasma polymorphonuclear (PMN) elastase levels in the 2 groups. There was a trend toward a greater decrease in the plasma PMN elastase in the sivelestat group than in the placebo group. (CPB = cardiopulmonary bypass; ● = sivelestat group, n = 7; □ = placebo group, n = 6.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Changes in the plasma interleukin (IL)-8 levels in the 2 groups. The plasma IL-8 level immediately after weaning from cardiopulmonary bypass (CPB) was significantly smaller in the sivelestat group (49.84 pg/mL ± 26.66 pg/mL) compared with the placebo group (85.00 pg/mL ± 39.19 pg/mL, p = 0.041). (*p < 0.05; ACC = aortic cross-clamp; ● = sivelestat group, n = 7; □ = placebo group, n = 6.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Changes in the plasma interleukin (IL)-10 levels in the 2 groups. The plasma IL-10 level was significantly lower in the sivelestat group than in the placebo group at 15 minutes after removal of the aortic cross-clamp (ACC) (200.37 pg/mL ± 236.79 pg/mL vs 380.00 pg/mL ± 45.72 pg/ mL, p = 0.048) and immediately after weaning from cardiopulmonary bypass (CPB) (277.47 pg/ mL ± 171.92 pg/ mL vs 503.33 pg/mL ± 240.92 pg/mL, p = 0.037). ) (*p < 0.05; ● = sivelestat group, n = 7; □ = placebo group, n = 6.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Changes in the plasma interleukin (IL-6) levels in the 2 groups. There were no significant differences between the 2 groups in the plasma IL-6 level. (● = sivelestat group, n = 7; □ = placebo group, n = 6.) The Annals of Thoracic Surgery 2013 96, 2184-2191DOI: (10.1016/j.athoracsur.2013.07.017) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions