Statins and cardiac surgery.

摘要

THE NUMBER OF cardiac surgeries continues to increase every year,1 and while the specialties of cardiac surgery, anesthesia, and critical care advance, residual morbidity and mortality persist.2 Reasons for these outcomes include the comorbidity that accompanies aging and the unique and complex pathophysiologic response to cardiac surgery. Whether conducted on or off bypass, cardiac surgery is associated with some degree of whole-body inflammatory reaction3'4 involving upregulation of circulating hematopoietic cells and stimulation of inflammatory, oxidative, and coagulation cascades. Cyto-kines and activated cells disseminate, producing distant organ as well as local myocardial damage. Because the body's response to cardiopulmonary bypass is complex, prevention and treatment strategies have been varied and to date have tended to target individual aspects of this diverse reaction, either in terms of the mechanism of injury or the organ affected. Disappointing results are all-too-familiar. However, a novel approach recently has been suggested and involves the adoption of concurrent, heterogenous strategies5 to cover the many aspects of the response to cardiopulmonary bypass. Although this is attractive, in reality it is suspected to be clinically challenging.5 A more practical solution to this approach would be to search for a single, multidimensional agent, which is much more clinically appropriate and very appealing.