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    Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass
    (Edizioni Minerva Medica, 2013) Cakir, H.; Gur, O.; Ege, T.; Kunduracilar, H.; Ketenciler, S.; Duran, E.
    Aim. The aim of our research is to investigate the cardiac damage formed by either local cardiac hypothermia or cardiac normothermia technique in patients who undergone isolated coronary artery bypass graft (CABG) surgery. Methods. The total of 40 patients who underwent isolated CABG operation under normothermic cardiopulmonary bypass (CPB) were studied. Patients were randomly divided into two groups as cardiac hypothermia and cardiac normothermia. Myocardial temperature was measured from the interventricular septum before aortic cross-clamp (ACC) (baseline), the ACC 20th minutes (ischemia) and after 20 minutes removal of the ACC (reperfusion). The coronary sinus blood samples were simultaneously obtained from the retrograde cardioplegia cannula while myocardial temperature was being measured. Complement component 3 (C3), complement component 4 (C4), troponin I and tumor necrosis factor-alpha (TNF-alpha) was measured from the coronary sinus blood samples. Results. Myocardial temperature was between 18-28 degrees C (deep hypothermia) during ACC in group 1. Myocardial temperature was over 34 degrees C (normothermia) during ACC in group 2. TNF-alpha values of group 1 for ischemia and reperfusion were higher than group 2, and it was found statistically significant (P<0.05). Conclusion. Myocardial damage was less than in normothermia group according to hypothermia group. The results show that ice-cold blood cardioplegia and local ice treatment of the heart during CPB seems to harm the heart more than warm blood cardioplegia.
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    In vitro effects of lidocaine hydrochloride on coronary artery bypass grafts
    (Edizioni Minerva Medica, 2012) Gur, O.; Ege, T.; Gurkan, S.; Gur, D. Ozkaramanli; Karadag, H.; Cakir, H.; Duran, E.
    Aim. Coronary artery bypass grafting (CABG) is one of the most common procedures performed to improve blood supply to myocardium. The characteristics of grafts, mechanical stress and pharmacological agents have substantial influence on the short and long term graft patency. Lidocaine is among the most frequently used antiarrhytlunic agents perioperatively. The aim of this study was to evaluate the in vitro effects of lidocaine on internal mammarian artery (IMA), radial artery (RA) and saphenous vein (SV) grafts. Methods. Using standard tissue bath techniques, responses to increasing concentrations of lidocaine hydrochloride were obtained, in segments of IMA, RA and SV grafts. Twenty patients were enrolled in the study with a total number of 48 grafts (16 for IMA, RA and SV grafts each). In vitro lidocaine concentrations between 10(-9)M and 10(-3.5)M were studied to represent therapeutic plasma concentration of 1.5-5 mcg/mL. Results. In IMA and RA grafts, lidocaine hydrochloride caused vasodilatation (40.5 +/- 1.9% and 39.1 +/- 2.6 % respectively) at concentrations between 10(-9) to 10(-7.5) M while causing a dose dependent vasoconstriction response at concentrations above 10(-7.5)M. In SV graft samples, lidocain hydrochloride caused vasodilatation (24.4 +/- 1.9 %) at concentrations between 10(-9) to 10(-7.5) M while causing dose dependent vasoconstriction at concentrations above 10(-7) M. For vasoconstriction effect, mean +/- SD values for E-max were calculated as: 120.1 +/- 6.6% in IMA, 83.35 +/- 5.06% in RA, and 154.0 +/- 13.8% in SV. The vasoconstriction in the SV samples was higher than in the RA and IMA. The mean SD LogEC(50) values were -5.15 +/- 0.27, -5.76 +/- 0.11 and -5.56 +/- 0.19 for SV, IMA and RA grafts respectively.) There was a statiscally significant differences in the Log EC50 values between SV, IMA and RA (P<0.005) Conclusion. Based on the results of our study, we conclude that, increasing doses of lidocaine in the perioperative period may cause vasospasm in IMA, RA and SV grafts. Thus, avoiding high doses may have a role in improving perioperative and long term mortality.