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Eur J Cardiothorac Surg 1998;13:385-391
© 1998 Elsevier Science NL

von Willebrand factor and urinary albumin excretion are possible indicators of endothelial dysfunction in cardiopulmonary bypass

Cardiothoracic Surgery Unit, University Hospital, Edgbaston, Birmingham B15 2TH, UK

Received 29 July 1997; received in revised form 1 December 1997; accepted 17 December 1997.

Corresponding author. Present address: Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry, CV2 2DX, UK. Tel.: +44 1203 602020; e-mail: g.m.k.tsang@bham.ac.uk

Objective: Experimental evidence suggests that cardiopulmonary bypass (CPB) associated inflammatory response leads to endothelial injury and increased permeability, but this has been difficult to show clinically. We have investigated the use of von Willebrand factor (vWF), and urinary albumin excretion, as measured by the urinary albumin creatinine ratio (ACR), to demonstrate this. Methods: A total of 23 patients undergoing elective coronary artery bypass grafting were studied. Complement fragment C3a, leukotrienne B4 (LTB4), interleukin 6 (IL6), neutrophil elastase, vWF and ACR were measured on anaesthetic induction (baseline), 20 min after starting CPB, 5 min after cross-clamp removal, 5 min, 2, 6 and 24 h after termination of CPB. Anaesthetic, CPB and myocardial protection techniques were standardised. ANOVA was performed by using the distribution free Friedman test for each measured parameter. When significance differences were found (P<0.05), post hoc analysis with Wilconson signed rank test was used for comparison of each time point with the base line level and differences were only accepted as significant following the Bonferroni correction (P<0.008). Summary measures of peak versus peak and area under the cure were also analysed for ACR with vWF. Results: Peak vs. baseline levels for C3a were 4.9 vs. 2.1 µg/ml (P<0.0001), LTB4 was 800 vs. 20 pg/ml (P<0.0001), neutrophil elastase was 250 vs. 115 ng/ml (P<0.001), IL6 was 620 vs. 1.4 pg/ml (P<0.0001), vWF was 2.2 vs. 1.3 IU/ml (P<0.0001) and ACR was 17.6 vs. 2.0 mg/mmol (P<0.0001). C3a, LTB4 and ACR peaked during the operation. Neutrophil elastase peaked at 2 h following CPB. IL6 and vWF peaked at 6 h following CPB. The correlation coefficient between vWF and ACR following peak versus peak analysis was 0.48 (P=0.035), and area under the curve analysis was 0.6 (P<0.0l). Conclusion: These results demonstrate that endothelial permeability and injury, as measured by urinary albumin excretion and vWF, respectively, are related and the use of these easily detectable and sensitive biochemical markers warrants further investigation.

Key Words: Cardiopulmonary bypass • Endothelial dysfunction • von Willebrand factor • Urinary albumin excretion

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