Effect of Anesthetics on CD39 and CD73 After Open-heart Surgery
Condition: Valvular Heart Disease; Aortic Disease
MeSH terms: Heart Diseases; Heart Valve Diseases; Aortic Diseases
Study type: Interventional
Phase: Phase 4

Summary: 
      CD39 and CD73 was known protein expressed on surface of Th1 and Th17 cell and modulate immune
      related reaction. Cardiopulmonary bypass (CPB) can induce inflammatory reaction during
      cardiac surgery, and induce immunosuppression. Propofol and volatile anesthetics were related
      to immune reaction. However, the effect of propofol and sevoflurane on the change of CD39 and
      CD73 after CPB was not evaluated in previous studies.

      The authors hypothesized that the expression of CD39 and CD73 would differ between propofol-
      and volatile anaesthetic-based anaesthesia in patients undergoing CPB. Therefore, the present
      study determined the effect of propofol and sevoflurane on CD39 and CD73 during and after
      CPB.
    

Detailed description: 
      After obtaining permission of the Institutional Review Board of Konkuk University Medical
      Center, Seoul, South Korea , patients scheduled to undergo elective cardiac surgery under
      cardiopulmonary bypass (CPB) after signed written informed consent agreements and
      prospectively participate in the present study.

      All patients got a cardiac surgery under moderate hypothermic cardiopulmonary bypass (CPB) by
      one cardiac surgeon. Also, 6ml of blood and sample was obtained for total 5 times in
      consecutive order.

        1. Before operation (pre-CPB1)

        2. 15 minute after successful CPB weaning (post-CPB1)

        3. 3 hrs after CPB weaning (post-CPB2)

        4. 24 hrs after CPB weaning (post-CPB3)

        5. 48 hrs after CPB weaning (post-CPB4)

      The following intraoperative exclusion criteria are applied:

        1. Emergency operation that could not obtain pre-CPB1 sample

        2. Patients who have infectious factor before operation

        3. Patients who have immunosuppressive agent for underlying disease before operation

        4. Patients who have history of cancer previously

        5. Patients who are younger than 19 years old

      Using blood sample, authors examined as follows

        1. Flow cytometry for Th 17 and Th 1 cell.

        2. Immunocytochemistry for CD39, CD73.

        3. Assay for IL 1,6,10,17,IFN-γ, and TNF-α

        4. patient vital sign during operation

        5. other laboratory tests

      Statistical analyses are conducted using SPSS 20.0 (SPSS Inc., Chicago, IL, USA). CD39 and
      CD73 are analysed used a Repeated Measures Analysis of Variance and their pairwise multiple
      comparisons are performed via the tukey method. The comparisons of the other continuous
      variables are performed by paired t or Wilcoxon Signed Rank tests. Data are expressed as mean
      ± SD (95% confidence interval. CI) or median (25%-75%), and number of the patients. A p value
      less than 0.05 is considered statistically significant.
    

Intervention name(s): Propofol; Sevoflurane
Intervention type(s): Drug; Drug
Intervention description(s): group of patients with propofol-based anesthesia; group of patients with sevoflurane-based anesthesia
Other intervention name(s): Propofol group; Sevoflurane group
Intervention MeSH terms: Propofol; Sevoflurane
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Basic Science