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Background: Circulating endothelial cells (CEC) are sensitive markers and direct evidence of endothelial damage induced by cardiopulmonary bypass (CPB). Remifentanil preconditioning (RP) has been demonstrated to attenuate CPB-induced organ damage, while whether the protection is related to reducing endothelial damage is unknown. This study aimed to investigate RP protection on vascular endothelial cells of patients undergoing open-heart surgery using CPB. Methods: 50 patients undergoing mitral valve replacement surgery were randomly assigned either to the RP group (n = 25) or the control group (C, n = 25). Perioperative data were recorded and blood samples were obtained preoperatively (baseline, pre-CPB, 5 minutes, 1, 6, 12 and 24 hours post aortic-cross-clamping). CEC-release and parameters of endothelial function (vWillebrand-Factor (vWF), soluble-thrombomodulin (sTM)), inflammation (Interleukin-6, TNFα), oxidative stress (MDA), myocardial cellular injury (CK-MB, troponin-I) and cerebral injury (S-100β) were measured. Results: Levels of CEC-release, parameters of myocardial (troponin-I, CK-MB) and cerebral injury (S-100β) were significantly increased after reperfusion compared to baseline or pre-CPB that were concomitant with significant increases in interleukin-6, TNFα and MDA (all P < 0.05). RP significantly attenuated the increase of all the above mentioned parameters as early as 5 minutes or 1 hour after reperfusion (aortic declamping) and onwards and improved post-operative cardiac function evidenced as significant enhancement of cardiac index (all P < 0.05 vs. control group). Conclusion: Remifentanil attenuates endothelial-myocardial injury in patients undergoing mitral valve replacement surgery and the mechanism might be attributable to reduction in oxidative stress and inflammation during myocardial ischemia and reperfusion.

translational perioperative and pain medicine

Remifentanil Reduces Oxidative Stress and Inflammation and Attenuates Endothelial-Myocardial Injury in Patients Undergoing Mitral Valve Replacement Surgery