Erythropoietin Effect on Ischemic_ Reperfusion Injury in Coronary Artery Bypass Graft Surgery

Not Applicable

Completed

Brief Summary: The aim of this trail is to assess the safety and therapeutic effects of single EPO intervention in different times during coronary surgery in changes of inflammatory response.

Detailed Description: In addition to well-known effect of Erythropoietin (EPO) on erythropoiesis in hypoxic conditions, some lines of evidence suggest its protective effects against reperfusion injury in several tissues by its specific receptor.

Preclinical studies have indicated a broad variety of cardioprotective actions for EPO. It improves cardiac function and exercise capacity in congestive heart failure, angiogenesis, limit myocardial inflammatory response, cardiac remodeling, infarct size and apoptosis extension induced by reperfusion injury. Activation of EPO receptor in endothelial and cardiac cells is suggested to attenuate proinflammatory cytokines production and inflammatory cells infiltration, and increasing nitric oxide production through possible mechanisms.

Reperfusion injury is unavoidable event during cardiac surgery using cardiopulmonary bypass.It is associated with inflammation, cell injury and attenuate contractility property.

Although it is an area of concern and many clinical studies have been designed by different interventions, it remains a major challenge. EPO intervention during heart reperfusion (surgery/ percutaneous angioplasty) as a new promise of cardioprotection strategy is the main design of several studies with conflicting results .

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
control	normal saline	50 ml normal saline infusion during aortic cross clamp in 45-60 minutes
group A	erythropoietin	20000 IU erythropoietin infusion during aortic cross clamp in 45-60 minutes
group B	erythropoietin	20000 IU erythropoietin infusion after induction of anesthesia and before undergoing cardiopulmonary bypass pump in 45-60 minutes

Primary Outcome Measures

Name	Time	Method
Change in Interleukin 6(IL6)	Change from baseline until 48 hours after surgery	Serum IL6(an inflammatory marker) level is measured before operation (base),just after operation,24 hours after operation,48 hours after operation
Change in YKL-40	Change from baseline until 48 hours after surgery	Chitinase-3-like protein 1 (CHI3L1), also known as YKL-40 is an inflammatory marker.Serum YKL-40 level is measured before operation (base),just after operation,24 hours after operation,48 hours after operation
Change in pro b-type natriuretic peptide(pro BNP)	Change from baseline until 48 hours after surgery	Serum pro BNP level is measured before operation (base),just after operation,24 hours after operation,48 hours after operation

Secondary Outcome Measures

Name	Time	Method
Volume of bleeding	During operation until 24 hours after surgery
Need to blood transfusion	During and after operation, through study completion,an average of one week	Number of packed cell and fresh frozen plasma that transfused in the period of time that patient is hospitalized.
Ventilation time	Period of time after surgery that patient has been intubated in ICU,an average of 10 hours

Locations (1): Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences.
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Tehran, Iran, Islamic Republic of

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