THE INFLUENCE OF CORONARY BYPASS ON ENDOTHELIAL AND ERECTILE DYSFUNCTION IN ISCHEMIC HEART DISEASE

Aim. To evaluate coronary bypass grafting under artificial circulation conditions on endothelial and erectile dysfunction in patients with ischemic heart disease (CHD). Material and methods. Totally 117 patients participated in the study, with stable CHD at the mean age 55,8±5,3 y.  o.,  planned to CBG. In all patients we used questionnaire “International Index of Erectile dysfunction” (IIED), registration of nocturnal penile tumescenses (NPT), post compression tests on brachial and cavernous arteries. All patients were divided into two groups, those with and without erectile dysfunction (ED) (n=60, n=57, resp.). Results. By the results of the investigation in patients with ED after CBG there was significant worsening of erectile function. It was found, that the existence of ED before operation is an important prognostic factor for its progression after the operation. Others, with non-affected erectile function, after the operation had higher chances to save it. Even more, it was found that in patients without preoperational ED by 6 months after CBG there was tendency to improvement of EZVD comparing with baseline values, but in group with ED this tendency was not found. Also in patients without ED in all stages of study there was significantly better vasoregulating function of endothelium on brachial artery comparing to ED patients. The same tendency was found and on cavernous arteries. While analyzing the prevalence of cardiovascular events after CBG it was found that in ED group 4 patients (7%) cardiovascular events developed, but without ED — did not. Conclusion. So the presence of ED might be a significant marker of worse outcome in CHD patients, underwent CBG.

1. Karpov YuA, Samko AN, Buza VV. Drug therapy and invasive management for stable CAD: how to make an adequate choice? Kardiologicheskij vestnik 2009; 2 (4): 4-8. Russian (Карпов Ю. А., Самко А. Н., Буза В. В. Медикаментозное и инвазивное лечение стабильной ИБС: как сделать правильный выбор? Кардиол. вестн. 2009, 2 (4): 4-8).

2. Pomeshkina SA, Pomeshkin EV, Sergeeva TJu, et al. Association between endothelial and erectile dysfunction in patients suffering from coronary artery disease. Klinicheskaja medicina 2012; 5: 32-5. Russian (Помешкина С. А., Помешкин Е. В., Cepгеева Т. Ю. и др. Взаимосвязь эндотелиальной и эректильной дисфункций у пациентов c ишемической болезнью сердца. Клиническая медицина 2012, 5: 32-5).

3. Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 2011; 58 (13): 1378-85.

4. Panagiotopoulos I, Palatianos G, Michalopoulos A, et al. Alterations in biomarkers of endothelial function following on-pump coronary artery revascularization. J Clin Lab Anal 2010; 24(6): 389-98.

5. Nia F, Abdollahi SK, Hekmatimoghaddam MH, et al. Incidence of sexual dysfunction in men after cardiac surgery in Afshar hospital, Yazd. Iranian Journal of Reproductive Medicine 2011; 9 (2): 89-94.

6. La Vignera S, Condorelli R, Vicari E, et al. Arterial erectile dysfunction: reliability of new markers of endothelial dysfunction. J Endocrinol Invest 2011; 34 (10): 314-20.

7. Persson G. Five-year mortality in a 70-year-old urban population in relation to psychiatric diagnosis, personality, sexuality and early parental death. Acta Psychiatr Scand 1981; 64: 244-53.

8. Smith DG, Frankel S, Yamell J. Sex and death: are they related? Findings from the Caterphilly Cohort Study BMJ 1997; 315: 1641-4.

9. Hizli F, I¨ler B, G¨ne¨ Z, et al. What is the best predictor of postoperative erectile function in patients who will undergo coronary artery bypass surgery? Int J Urol Nephrol. 2007; 39 (3): 909-12.

10. Mohamed OA, Hamed HA, Roaiah MF, et al. Vascular risk factors as predictors of sexual function following coronary artery bypass graft. J Sex Med 2009; 6 (7): 2017-23.

11. Bernardo A. Sexuality in patients with coronary disease and heart failure. Herz. 2001; 26: 353-9.

12. Nair S, Iqbal K, Phadke M, et al. Effect of cardiopulmonary bypass on tissue injury markers and endothelial activation during coronary artery bypass graft surgery. J Postgrad Med. 2012; 58 (1): 8-13.

13. Kalinichenko AP, Lomivorotov VV, Kornilov IA, et al. Effect of methylprednisolone on endothelial dysfunction in cardiac surgeries with extracorporeal circulation. Patologija krovoobrashhenija i kardiohirurgija 2011, 1: 30-4. Russian (Калиниченко А. П., Ломиворотов В. В., Корнилов И. А. и др. Влияние метилпреднизолона на эндотелиальную функцию при кардиохирургических операциях в условиях искусственного кровообращения. Патология кровообращения и кардиохирургия 2011, 1: 30-4).

14. Canguven O, Albayrak S, Selimoglu A, et al. The Effect of cardiopulmonary bypass in coronary artery bypass surgeries (on-pump versus off-pump) on erectile function and endothelium-derived nitric oxide levels. International Braz J Urol 2011; 37 (6): 733-8.

15. Mohamed OA, Bennett CJ, Roaiah MF, et al. The impact of on-pump coronary artery bypass surgery vs. off-pump coronary artery bypass surgery on sexual function. J Sex Med. 2009; 6: 1081-9.

16. Shafranskaja KS, Kazachek JaV, Kashtalap VV. Incidence of adverse cardiovascular events in patients with polyvascular disease of different severity undergone coronary artery bypass grafting surgery. Medicina v Kuzbasse 2011, 3: 40-5. Russian (Шафранская К. С., Казачек Я. В., Кашталап В. В. Частота развития неблагоприятных сердечно-сосудистых событий у пациентов с мультифокальным атеросклерозом различной степени выраженности, подвергшихся коронарному шунтированию. Медицина в Кузбассе 2011, 3: 40-5).

17. Pomeshkina SA, Pomeshkin EV, Nejmark AI, et al. The relationship of psycho-emotional and erectile dysfunctions in men undergone coronary artery bypass grafting surgery. Lechashhij vrach 2011, 9: 32-5. Russian (Помешкина С. А., Помешкин Е. В., Неймарк А. И. Взаимосвязь психоэмоциональных и эректильной дисфункций у мужчин, подвергшихся коронарному шунтированию. Лечащий врач 2011, 9: 32-5).