Myocardial Protection Era: From Valve Surgery to Heart Transplantation

Salerno, Tomás A.

doi:10.1111/j.1525-1594.2012.01571.x

Cited by 3 publications

(2 citation statements)

References 18 publications

(19 reference statements)

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“…Perioperative myocardial injury remains one of the most serious complications of cardiac surgery (1–3), and numerous factors have been implicated during the pathogenesis process, including the technique of cardiac surgery, induction of cardioplegia and period of cardiac arrest (4–6). The primary mechanisms underlying myocardial dysfunction in this process are ischemic-reperfusion injury and the associated inflammatory responses (6–9).…”

Section: Introductionmentioning

confidence: 99%

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A pilot study of perioperative esmolol for myocardial protection during on-pump cardiac surgery

Liu

Shao

Liu

et al. 2016

Experimental and Therapeutic Medicine

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The protective effects of preprocedural esmolol on myocardial injury and hemodynamics have not, to date, been investigated in patients who were scheduled for cardiac surgeries under a cardiopulmonary bypass (CPB). A pilot randomized controlled trial was performed at The First Affiliated Hospital of Dalian Medical University (Dalian, China). Patients scheduled for elective open-heart surgeries under CBP were included, and were randomized to esmolol and control groups. For patients in the esmolol groups, intravenous esmolol (70 µg/kg/min) was administered at the time of incision until CPB was performed. For patients assigned to the control group, equal volumes of 0.9% saline were administered. Markers of myocardial injury and hemodynamic parameters were observed until 12 h post surgery. A total of 24 patients were included in the present study. No significant differences in hemodynamic parameters, including the central venous pressure and heart rate, were detected between patients in the two groups during the perioperative period or within the first 12 h post-surgery (P>0.05), except for the mean arterial pressure, which was higher in the esmolol group compared with the control group at 5 and 12 h post-surgery (P<0.05). However, the serum level of cardiac troponin I was higher in patients of the control group compared with those of the esmolol group during the preoperative period (P<0.05). Although creatinine kinase was significantly different at T2 between the two groups, its MB isoenzyme was not significantly different between the groups (P>0.05). In addition, administration of esmolol was not associated with an increased risk for severe complications and adverse events in these patients. In conclusion, preoperative esmolol may be an effective and safe measure of myocardial protection for patients who undergo elective cardiac surgeries under CBP.

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Section: Introductionmentioning

confidence: 99%

“…The primary mechanisms underlying myocardial dysfunction in this process are ischemic-reperfusion injury and the associated inflammatory responses (6–9). Several cardioprotective agents have been investigated for preventing iatrogenic myocardial injury.…”

Section: Introductionmentioning

confidence: 99%

A pilot study of perioperative esmolol for myocardial protection during on-pump cardiac surgery

Liu

Shao

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Dilong Prevents the High-KCl Cardioplegic Solution Administration-Induced Apoptosis in H9c2 Cardiomyoblast Cells Mediated by MEK

et al. 2014

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Infusion of high-KCl cardioplegic solution (High-KCS) is the most common method used to induce asystole before cardiac surgery. However, our previous study showed the High-KCS can cause the apoptosis of cardiomyocytes in patients who were administered High-KCS prior to undergoing coronary artery bypass graft (CABG) to treat coronary artery disease (CAD). Therefore, it is urgent today to find a complementary medicine to reduce this damage. Dilong (earthworm) has been used as a traditional medicine in China for several thousand years, and extract from the dilong has been empirically used in Asia for the treatment of vascular disorders. In this study, we applied dilong extract to reduce myocardial cell damage from High-KCS infusion and further investigated the mechanisms. H9c2 cardiomyoblast cells were cultured in serum-free medium for 4 h and then treated with dilong at 31.25, 62.5, 125, and 250 mg/mL for 24 h, which was then followed by High-KCS treatment for 3 h to detect the protective mechanisms of dilong behind cardiomyocyte apoptosis and cardiac fibrosis. Cells were harvested for MTT assay, TUNEL assay, and western blot analysis. We found that High-KCS-induced cardiomyocyte apoptosis, enhanced the protein level of pro-apoptotic Bad, released cytochrome c, and activated caspase-3 in H9c2 cells. The IGF-I/IGF-IR/ERK pathway involved in non-cardiomyocyte proliferation, and the expression/activation of uPA, Sp-1 and CTGF, which are implicated in the development of cardiac fibrosis were up-regulated, but the Akt for cardiomyocyte survival was greatly deactivated in postcardioplegic H9c2 cardiomyoblast cells. However, dilong was highly protective and totally reversed the apoptosis and cardiac fibrosis effects induced by High-KCS. Chemical inhibitors P38 (SB203580), JNK (SP600125), MEK (U0126), IGF-1 (AG1024), and PI3K (LY294002) were applied to investigate which is the mediator for dilong attenuated High-KCS stimulated caspase 3 activation. MEK (U0126) inhibitor completely blocked dilong inhibited caspase 3 activation in High-KCS treated H9c2 cells. The MEK siRNA was further applied to knockdown MEK to confirm our finding. We found dilong worked through MEK to inhibit caspase 3 activity induced by High-KCS in H9c2 cells. Furthermore, we used the pure component of dilong, Lumbrokinase, to block the High-KCS effect. Using the microscope to observe the cell viability, we found Lumbrokinase could reverse the High-KCS effect. Lumbrokinase could also reduce the protein levels of caspase 8, caspase 9, and caspase 3, and enhance the survival related proteins PI3K/Akt and Bcl2. These results demonstrate that dilong could be used as a potential agent to block the side effects caused by High-KCS in CABG surgery patients.

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Effect of Xuebijing injection on myocardium during cardiopulmonary bypass: A prospective, randomized, double blind trial

Jin¹,

Zhao²,

Sun³

et al. 2022

WJCC

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Myocardial Protection Era: From Valve Surgery to Heart Transplantation

Cited by 3 publications

References 18 publications

A pilot study of perioperative esmolol for myocardial protection during on-pump cardiac surgery

A pilot study of perioperative esmolol for myocardial protection during on-pump cardiac surgery

Dilong Prevents the High-KCl Cardioplegic Solution Administration-Induced Apoptosis in H9c2 Cardiomyoblast Cells Mediated by MEK

Effect of Xuebijing injection on myocardium during cardiopulmonary bypass: A prospective, randomized, double blind trial

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