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Article

Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery

1
Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
2
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
3
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
4
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, 80636 Munich, Germany
5
Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsmedizin Rostock, 18057 Rostock, Germany
6
Department of Endocrinology and Metabolic Medicine, Division of Lipid Metabolism, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
7
Department of Cardiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
*
Author to whom correspondence should be addressed.
Equally contributing first authors.
Academic Editors: Tania Garfias-Veitl and Stephan von Haehling
Cells 2021, 10(10), 2717; https://doi.org/10.3390/cells10102717
Received: 20 August 2021 / Revised: 4 October 2021 / Accepted: 9 October 2021 / Published: 11 October 2021
(This article belongs to the Special Issue Understanding Biomarkers in Cardiology)
Patients undergoing cardiac surgery are at increased cardiovascular risk, which includes altered lipid status. However, data on the effect of cardiac surgery and cardiopulmonary bypass (CPB) on plasma levels of key lipids are scarce. We investigated potential effects of CPB on plasma lipid levels and associations with early postoperative clinical outcomes. This is a prospective bio-bank study of patients undergoing elective cardiac surgery at our center January to December 2019. The follow-up period was 1 year after surgery. Blood sampling was performed before induction of general anesthesia, upon weaning from cardiopulmonary bypass (CPB), and on the first day after surgery. Clinical end points included the incidence of postoperative stroke, myocardial infarction, and death of any cause at 30 days after surgery as well as 1-year all-cause mortality. A total of 192 cardiac surgery patients (75% male, median age 67.0 years (interquartile range 60.0–73.0), median BMI 26.1 kg/m2 (23.7–30.4)) were included. A significant intraoperative decrease in plasma levels compared with preoperative levels (all p < 0.0001) was observed for total cholesterol (TC) (Cliff’s delta d: 0.75 (0.68–0.82; 95% CI)), LDL-Cholesterol (LDL-C) (d: 0.66 (0.57–0.73)) and HDL-Cholesterol (HDL-C) (d: 0.72 (0.64–0.79)). At 24h after surgery, the plasma levels of LDL-C (d: 0.73 (0.650.79)) and TC (d: 0.77 (0.69–0.82)) continued to decrease compared to preoperative levels, while the plasma levels of HDL-C (d: 0.46 (0.36–0.55)) and TG (d: 0.40 (0.29–0.50)) rebounded, but all remained below the preoperative levels (p < 0.001). Mortality at 30 days was 1.0% (N = 2/192), and 1-year mortality was 3.8% (N = 7/186). Postoperative myocardial infarction occurred in 3.1% of patients (N = 6/192) and postoperative stroke in 5.8% (N = 11/190). Adjusting for age, sex, BMI, and statin therapy, we noted a protective effect of postoperative occurrence of stroke for pre-to-post-operative changes in TC (adjusted odds ratio (OR) 0.29 (0.07–0.90), p = 0.047), in LDL-C (aOR 0.19 (0.03–0.88), p = 0.045), and in HDL-C (aOR 0.01 (0.00–0.78), p = 0.039). No associations were observed between lipid levels and 1-year mortality. In conclusion, cardiac surgery induces a significant sudden drop in levels of key plasma lipids. This effect was pronounced during the operation, and levels remained significantly lowered at 24 h after surgery. The intraoperative drops in LDL-C, TC, and HDL-C were associated with a protective effect against occurrence of postoperative stroke in adjusted models. We demonstrate that the changes in key plasma lipid levels during surgery are strongly correlated, which makes attributing the impact of each lipid to the clinical end points, such as postoperative stroke, a challenging task. Large-scale analyses should investigate additional clinical outcome measures. View Full-Text
Keywords: lipid; LDL; HDL; triglycerides; cholesterol; cardiac surgery; cardiopulmonary bypass lipid; LDL; HDL; triglycerides; cholesterol; cardiac surgery; cardiopulmonary bypass
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MDPI and ACS Style

Mihalj, M.; Heinisch, P.P.; Huber, M.; Schefold, J.C.; Hartmann, A.; Walter, M.; Steinhagen-Thiessen, E.; Schmidli, J.; Stüber, F.; Räber, L.; Luedi, M.M. Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery. Cells 2021, 10, 2717. https://doi.org/10.3390/cells10102717

AMA Style

Mihalj M, Heinisch PP, Huber M, Schefold JC, Hartmann A, Walter M, Steinhagen-Thiessen E, Schmidli J, Stüber F, Räber L, Luedi MM. Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery. Cells. 2021; 10(10):2717. https://doi.org/10.3390/cells10102717

Chicago/Turabian Style

Mihalj, Maks, Paul P. Heinisch, Markus Huber, Joerg C. Schefold, Alexander Hartmann, Michael Walter, Elisabeth Steinhagen-Thiessen, Juerg Schmidli, Frank Stüber, Lorenz Räber, and Markus M. Luedi 2021. "Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery" Cells 10, no. 10: 2717. https://doi.org/10.3390/cells10102717

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