Document Type : Research articles

Authors

• Abbas Sedighinejad ¹
• Vali Imantalab ¹
• Ali Mirmansouri ¹
• Ali Mohammadzadeh Jouryabi ¹
• Nassir Nassiri Sheikhani ²
• Bahram Naderi Nabi ³
• Mohammad Haghighi ⁴
• Gelareh Biazar ⁵
• Zahra Atrkarroushan ⁶

¹ MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran

² MD, Department of Cardaic Surgery, Assistant Professor of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran

³ MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia and pain (FIPP), Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, IR Iran

⁴ MD, Associate Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran

⁵ MD, Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran

⁶ PhD, Assistant Professor of Biostatistic, Guilan University of Medical Sciences (GUMS), Rasht, Iran

Abstract

Background: In patients with coronary artery stenosis, coronary artery bypass graft surgery (CABG) is the most effective strategy to limit infarct size and improving outcomes. However, the rapid restoring of blood flow to the tissue can paradoxically induce cardiac damage. This phenomenon termed as myocardial ischemic/reperfusion (I/R) injury which is exacerbated under cardiopulmonary bypass (CPB) and is the cause of poor clinical outcomes. Therefore, it is essential to search for novel strategies with further cardio protective effects.
Objectives: In the current study, we investigated the effects of selenium (Se) administration on I/R injury in CABG patients.
Methods: This randomized double-blind clinical trial was conducted in the department of cardiac surgery of a university hospital in North of Iran from May 2015 to September 2015. One hundred and ten patients undergoing an elective isolated CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received either intravenous Se before induction of anesthesia, or normal saline as placebo. Cardiac troponin I (CTnI) and creatine kinase-MB (CKMB) were measured as biomarkers at four measurement point times, before the intervention (T0), at 6, 12, 24 and 48 hours after the surgery (T1-T4).
Results: Finally, data from 104 patients were analyzed, the Se (n = 53) and control (n = 51) groups. There was no significant difference between the two groups regarding the baseline characteristics. In both groups CPB caused a markedly increase in CKMB and CTnI plasma concentrations compared to the baseline (P = 0.0001). Based on CKMB, there was no significant difference between the two groups at any point times, T0 (P = 0.357), T1 (P = 0.751), T2 (P = 0.46), T3 (P = 0.16) and T4 (P = 0.053). According to CTnI, there was just a significant difference between the two groups at T1 (P = 0.011) but not at T2 (P = 0.116), T3 (P = 0.09) and T4 (P = 0.634). No adverse effect was recorded linked to our intervention.
Conclusions: Selenium can alleviate I/R injury in short time. Further well-planned trials are needed to find the optimized administration method to achieve the most beneficial effects to the patients.

Keywords

• Coronary Artery Bypass Graft Surgery
• Selenium
• CKMB
• CTnI