Effects of preoperative homocysteine levels on postoperative outcomes and adverse events in patients undergoing on-pump cardiac surgery

Objectives: Besides the well-known risk factors for atherosclerosis and cardiovascular disorders, hyperhomocystinemia is a recently defined factor that acts in pathogenesis of atherosclerotic diseases. It also plays role in development of end-stage renal disease. Homocysteine causes endothelial cell damage and proliferation in vascular smooth muscle cells. In this study, we aimed to document the relationship between serum homocyteine levels and postoperative outcomes and occurrence of postoperative adverse events in patients undergoing on-pump cardiac surgery. Materials and Methods: Forty patients undergoing on-pump cardiac surgery were included in the study. Serum homocysteine levels were measured preoperatively. Then, patients were divided into two groups; first group included patients with homocyteine levels below 15 mmol/l and second above. Cross-clamp and cardiopulmonary bypass times, intubation times, intensive care unit and hospital length of stay and occurrence of postoperative adverse events were compared between the two groups. Results: The mean age of the patients was 57.0 ± 2.3 and mean body mass index (BMI) was 26.8 ± 4.1. There were 30 male (75%) and 10 female (25%) patients. The mean preoperative Hcy level was 18.6 ± 10.5 mmol/l. Twenty one patient (52.5%) had Hcy levels below 15 mmol/l and 19 (47.5%) had above 15 mmol/l. The preoperative demographic characteristics of the patients were comparable in two groups. Intubation times, intensive care unit and hospital length of stay were not different between the groups. There was not statistically significant difference between the groups when postoperative renal functions designated by serum creatinine levels and urine output, mortality, occurrence of stroke and mesenteric vascular events were compared. Conclusions: We did not observe any relationship between elevated levels of homocysteine and postoperative stoke, renal failure and other adverse events. We believe that further studies with increased number of patients should be performed.