LOWER CARDIAC TROPONIN-T LEVELS IN PATIENTS UNDERGOING CARDIOPULMONARY BYPASS AND RECEIVING HIGH-DOSE APROTININ THERAPY INDICATE REDUCTION OF PERIOPERATIVE MYOCARDIAL DAMAGE

Nowadays in many European heart centers the activation of the fibrinol ytic system, always occurring during cardiopulmonary bypass, is routin ely reduced by high-dose application of the proteinase inhibitor aprot inin (total of >4 million KIU). In this study parameters of myocardial ischemic injury were investigated with the aim of identifying further benefits of aprotinin, particularly the protection of the myocardium during the ischemic period of aortic crossclamping, Forty patients wit h coronary artery disease who underwent aorta-coronary bypass grafting were randomly and in a double-blind fashion divided into two groups, one that received high-dose aprotinin therapy and one that received on ly saline solution, Markers such as troponin T, with high specificity for detection of myocardial ischemia and infarction, and markers with more general specificity such as creatine kinase, its isoenzyme, and l actate dehydrogenase showed significantly increased values after ische mia in both groups, In patients who received high-dose aprotinin thera py 3 days after cardiopulmonary bypass all parameters measured showed significantly lower levels compared,vith those in the control group, T herefore we can presume that the application of high-dose aprotinin pr ovides myocardial protection from perioperative ischemic injury.