Please select the eligibility criteria that correspond to the clinical trial below.
Title: Bradykinin Receptor Antagonism During Cardiopulmonary Bypass
Brief Summary: Each year over a million patients worldwide undergo cardiac surgery requiring cardiopulmonary bypass (CPB). CPB is associated with significant morbidity including the transfusion of allogenic blood products, inflammation and hemodynamic instability. In fact, approximately 20% of all blood products transfused are associated with coronary artery bypass grafting procedures. Transfusion of allogenic blood products is associated with well-documented morbidity and increased mortality after cardiac surgery. Enhanced fibrinolysis contributes to increased blood product transfusion in the perioperative period. The current proposal tests the central hypothesis that endogenous bradykinin contributes to the hemodynamic, fibrinolytic and inflammatory response to CPB and that bradykinin receptor antagonism will reduce hypotension, inflammation and transfusion requirements. In SPECIFIC AIM 1 we will test the hypothesis that the fibrinolytic and inflammatory response to CPB differ during ACE inhibition and angiotensin II type 1 receptor antagonism. In SPECIFIC AIM 2 we will test the hypothesis that bradykinin B2 receptor antagonism attenuates the hemodynamic, fibrinolytic, and inflammatory response to CPB. In SPECIFIC AIM 3 we will test the hypothesis that bradykinin B2 receptor antagonism reduces the risk of allogenic blood product transfusion in patients undergoing CPB. These studies promise to provide important information regarding the effects of drugs that interrupt the RAS and generate new strategies to reduce morbidity in patients undergoing CPB.


Options:
A: Inclusion Criteria:

* Atrial or ventricular septum defect patients requiring cardiac surgery with CPB
* Rheumatic or recessive valvular patients requiring valvular repair or replacement with CPB
* Coronary artery disease patients requiring coronary revascularization surgery with CPB

Exclusion Criteria:

* Non-primary cardiac surgery
* Definite liver or renal dysfunction
* Disorder in coagulation function
* Allergy
* Pregnancy or lactation
* Disabled in spirit or law
* Fatal conditions such as tumour
B: Inclusion Criteria:

* Elective complex cardiac surgery (combined valve and coronary bypass grafting surgery, concomitant valve surgery, surgery of the ascending aorta and aortic arch, as well as re-operations of the same type)
* Age \> 18 years

Exclusion Criteria:

* Disagreement to participate in the study
* Age \< 18 years
* Pregnancy
* Emergency procedure
* Heart transplantation
* Implantation of LVAD (left ventricular assist device), RVAD (right ventricular assist device) or TAH (total artificial heart)
* Treatment with chemotherapy, immunosuppressive therapy
* Treatment with anti-leukocyte drugs or TNF-alfa blockers
* Immunocompromised patients (AIDS), leucopenia (\< 4,0x109 / L)
* Clinical and/or laboratory signs of infection (CRP \>2 mg/dl)
* Serum creatinine \>2 mg/dl
* Bilirubin \>2 mg/dl
* History of stroke
* Malnourished patients, BMI \< 18
C: Inclusion Criteria:

* Age over 18 years
* Cardiac Surgery elective of coronary artery bypass graft with cardiopulmonary bypass (CPB)
* The informed consent signature savvy

Exclusion Criteria:

* Use of steroids or anti-inflammatory drugs routine
* Presence of asthma, COPD, autoimmune diseases
* Participation in other clinical studies
* Presence of decompensated heart failures, liver or kidney
* Combined elective surgery (ex .: aneurysm correction + CABG)
* Acute myocardial infarction in the last 30 days
* Unstable angina
* And obesity (BMI\> 50kg / m2)
D: Inclusion Criteria:

1. Subjects, 18 to 80 years of age, scheduled for elective CABG requiring CPB
2. For female subjects, the following conditions must be met:

postmenopausal for at least 1 year, or status-post surgical sterilization, or if of childbearing potential, utilizing adequate birth control and willing to undergo urine beta-hcg testing prior to drug treatment and on every study day

Exclusion Criteria:

1. Evidence of coagulopathy (INR greater than 1.7 without warfarin therapy)
2. Preoperative hematocrit less than 30%
3. Preoperative platelet count less than 100X109ml-1
4. GPIIb/IIIa antagonist within 48 hours of surgery
5. Emergency surgery
6. Impaired renal function (serum creatinine \>1.6 mg/dl)
7. Pregnancy
8. Breast-feeding
9. Any underlying or acute disease requiring regular medication which could possibly pose a threat to the subject or make implementation of the protocol or interpretation of the study results difficult
10. History of alcohol or drug abuse
11. Treatment with any investigational drug in the 1 month preceding the study
12. Mental conditions rendering the subject unable to understand the nature, scope and possible consequences of the study
13. Inability to comply with the protocol, e.g. uncooperative attitude and unlikelihood of completing the study

Answer: D