Relevance and Recommendations for the Application of Cardioplegic Solutions in Cardiopulmonary Bypass Surgery in Pigs

Glöckner, Anna; Oßmann, Susann; Ginther, André; Kang, Jagdip; Borger, Michael A.; Hoyer, Alexandro; Dieterlen, Maja‐Theresa

doi:10.3390/biomedicines9091279

Cited by 2 publications

(2 citation statements)

References 62 publications

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“…Cardiopulmonary bypass (CPB) is a sophisticate biomechanical technique of extracorporeal circulation that is broadly used by cardiac surgeries to temporarily sustain the physiological functions of the principal organs of patients by maintaining an appropriate circulation of blood flow and oxygen (1,2). Indeed, CPB circuits rejected by the circulating blood inevitably initiate inflammatory responses, predisposing to induce postoperative complications, such as lung injury, acute kidney injury (AKI), and hemolysis (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Zhang¹,

Li²,

An³

et al. 2023

Shock

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Introduction: Acute lung injury (ALI) is a devastating pulmonary illness with diffuse inflammatory responses. Hydromorphone (Hyd) is an opioid agonist used for relieving moderate-to-severe pain. The present work investigated the effect of Hyd on cardiopulmonary bypass (CPB)-induced ALI by regulating pyroptosis of alveolar macrophages (AMs). Methods: Rats were subjected to CPB, followed by Hyd treatment. The lung injury in rat lung tissues was appraised by the ratio of lung wet/dry weight (weight), histological staining, and the total protein concentrations in bronchoalveolar lavage fluid, and lung function was assessed by oxygenation index and respiratory index, and lung macrophage pyroptosis was observed by fluorescence staining. Alveolar macrophages were separated and pyroptosis was determined by western blot assay and enzyme-linked immunosorbent assay. The expression patterns of nuclear factor erythroid 2-related factor 2/heme oxygenase 1 (Nrf2/HO-1), nod-like receptor protein 3 (NLRP3), N-terminal gasdermin-D, and cleaved caspase-1 were examined by real-time quantitative polymerase chain reaction, western blot, and immunohistochemistry assays. The impact of NLRP3 or Nrf2 on pyroptosis of AMs and CPB-induced ALI was observed after treatment of nigericin (NLRP3 agonist) or ML385 (Nrf2 inhibitor). Results: Hyd attenuated CPB-induced lung injury as manifested by reductions in lung inflammation and edema, the scores of lung injury, the ratio of lung wet/dry weight, and the total protein concentrations in bronchoalveolar lavage fluid. Besides, Hyd repressed NLRP3 inflammasome-mediated pyroptosis of AMs after CPB treatment. Hyd upregulated Nrf2/HO-1 expression levels to repress NLRP3 inflammasome-mediated pyroptosis. Treatment of nigericin or ML385 counteracted the role of Hyd in ameliorating pyroptosis of AMs and CPB-induced ALI. Conclusions: Hyd alleviated NLRP3 inflammasome-mediated pyroptosis and CPB-induced ALI via upregulating the Nrf2/HO-1 pathway, which may be achieved by AMs.

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Section: Introductionmentioning

confidence: 99%

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Zhang¹,

Li²,

An³

et al. 2023

Shock

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“…During open-heart surgery, it is necessary for the heart to be relaxed and still (non-beating) and for the operative field to be blood-free. The easiest way to achieve a silent operating field is to induce global ischemia to the heart by cross-clamping the aorta, with systemic blood circulation transferred to a heart–lung machine [ 3 , 4 ]. Although convenient for the surgeon, ischemia that occurs during the procedure is detrimental and can be tolerated for only a few minutes without additional protection [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Cardioplegia in Open Heart Surgery: Age Matters

Bradić

Andjić

Jeremić

et al. 2023

JCM

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Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia–reperfusion (I–R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens. Material and methods: The PubMed database was searched using the terms cardioplegia, I–R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review. Conclusions: A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc.

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Relevance and Recommendations for the Application of Cardioplegic Solutions in Cardiopulmonary Bypass Surgery in Pigs

Cited by 2 publications

References 62 publications

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Cardioplegia in Open Heart Surgery: Age Matters

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