Warm reperfusion and myocardial protection

Chocron, Sidney; Alwan, Kifah; Yan, Yusheng; Toubin, Gérard; Kaili, Djamel; Anguenot, T; Latini, L.; François, Clément; Viel, Jean-François; Etievent, Joseph-Philippe

doi:10.1016/s0003-4975(98)00909-6

Cited by 21 publications

(17 citation statements)

References 11 publications

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“…Moreover, the results of many studies in cardiac surgery have been based on the hypothesis that higher postoperative cTnI levels indicate more myocardial injury. [32][33][34][35][36][37][38][39][40][41] It has been implied that because higher cTnI levels are seen after CABG with cardiopulmonary bypass, off-pump surgery infl icts less myocardial injury. 54 Three mechanisms for post-cardiac surgery serum cTnI elevation have been suggested: myocardial ischemia-reperfusion injury, mechanical cardiac trauma, and re-transfusion of shed mediastinal blood rich in troponin, during or after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Plasma Troponin Levels after Cardiac Surgery vs after Myocardial Infarction

Abramov

Tailakh

Frieger

et al. 2006

Asian Cardiovasc Thorac Ann

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Raised plasma troponin, a diagnostic marker for myocardial infarction, usually occurs after cardiac surgery, leading to difficulties in diagnosing postoperative myocardial infarction. To ascertain whether the same processes influence troponin elevation in both conditions, a literature search was performed for plasma troponin elimination curves after myocardial infarction, myocardial infarction with reperfusion, and cardiac surgery. From 70 studies, 11 curves using the Stratus immunoassay kit were analyzed: 5 post-cardiac surgery (412 patients), 2 after myocardial infarction with reperfusion (169 patients), and 4 after myocardial infarction (640 patients). For each group, a new plot was formulated from the mean troponin level at each time interval. While the up-slope of the cardiac surgery curve was much steeper than that of myocardial infarction, resembling that of myocardial infarction with reperfusion, its down-slope was significantly more gentle than that of both other groups (-0.91 vs -5.31, t = 3.47, df = 8, p < 0.01). This suggests that postoperative troponin elevation involves enhanced cell permeability as seen after ischemia reperfusion rather than permanent cellular damage. The gentler down-slope may point to surgery-induced impaired troponin removal from the circulation. Due to the different mechanisms proposed, implications from post-myocardial infarction troponin levels may not be conferred on post-cardiac surgery patients.

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Section: Discussionmentioning

confidence: 99%

Plasma Troponin Levels after Cardiac Surgery vs after Myocardial Infarction

Abramov

Tailakh

Frieger

et al. 2006

Asian Cardiovasc Thorac Ann

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“…[19][20][21] Aortic cross-clamping induces myocardial ischemia, which results in increased serum levels of the usual biochemical markers such as creatine kinase-MB, and troponin I or T. 22) It is also known that creatine kinase-MB specificity to detect myocardial injury may be less than that of cardiac troponin I and T. 23) Chocron, et al showed that cTnI release correlates with the extent of ischemic injury. 24) All these data confirmed that cardiac troponin release after cardiac surgery is a good reflection of the extent of myocardial damage due to ischemic injury. 8) It has been also suggested that cardiac troponin I (cTnI) specificity to detect myocardial injury may be greater than that of cardiac troponin T. 23) For this reason, in the present study, we measured serum cardiac TnI levels to detect the during ischemia and reperfusion.…”

Section: Discussionmentioning

confidence: 53%

Beneficial Effect of the Addition of Nitroglycerin to the Cardioplegic Solution on Lipid Peroxidation During Coronary Artery Bypass Surgery

Yavuz¹,

Altuntaş²,

Odabaşı³

et al. 2005

Int. Heart J.

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SUMMARYThe effects of the addition of a nitric oxide (NO) donor to the cardioplegic solution on reperfusion injury and lipid peroxidation (LPO) in coronary artery bypass grafting (CABG) are not known. Therefore, this work was conducted to determine the possible effects of nitroglycerin on LPO and reperfusion injury as a result of CABG.A prospective double-blind, placebo-controlled study was conducted in 30 consecutive patients with coronary artery disease who underwent CABG with cardiopulmonary bypass. The patients were randomly assigned to receive 3 µg/kg of nitroglycerin added to the cardioplegic solution (NTG group) or 3 µg/kg of placebo added to the cardioplegic solution (placebo group).MDA increased significantly in the placebo group compared to the NTG group during the ischemic (P < 0.01) and reperfusion periods (P < 0.01). The level of troponin I decreased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.001). The level of NO increased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.01).LPO was increased in response to CPB during CABG, together with simultaneous decreases in serum nitric oxide levels, whereas LPO was significantly decreased in response to CPB with nitroglycerin, together with simultaneous increases in the levels of serum nitric oxide. (Int Heart J 2005; 46: 45-55)

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“…The crystalloid cardioplegia at 4°C obviously reduces the metabolic needs; however, it is not enough to provide adequate protection [1] and warm reperfusion that provides immediate recovery of cardiac function which reverses protection induced by cold crystalloid cardioplegia [2].…”

Section: Introductionmentioning

confidence: 99%

"Non Working Beating Heart"

Dinkhuysen¹,

Contreras²,

Cipullo³

et al. 2011

Rev Bras Cir Cardiovasc

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Background and Objective: We attempt to reduce the ischemic time during implantation of the donor heart in the bicaval bipulmonary orthotopic position using normothermic beating heart and thus, facilitate the transplanted heart adaptation to the recipient. This study presents a small experience about a new strategy of myocardial protection during heart transplant.Methods: In cardiopulmonary bypass, the aorta anastomosis was done first, allowing the coronary arteries to receive blood flow and the recovering of the beats. The rest of the anastomosis is performed on a beating heart in sinus rhythm. The pulmonary anastomosis is the last to be done. This methodology was applied in 10 subjects: eight males, age 16-69 (mean 32.7 years), SPAo 90-100 mmHg (mean 96 mmHg), SPAP 25-65 mmHg (mean 46.1 mmHg), PVR 0.9 to 5.0 Wood (mean 3.17 Wood), GTP 4-13 mmHg (mean 7.9 mmHg), and eight male donors, age 15-48 years (mean 27.7 years), weight 65-114 kg (mean 83.1 kg). Causes of brain coma: encephalic trauma in five hemorrhagic stroke in four, and brain tumor in one.Results: The ischemic time ranged from 58-90 minutes (mean 67.6 minutes) and eight donors were in hospitals of Sao Paulo and two in distant cities. All grafts assumed the cardiac output requiring low-dose inotropic therapy and maintained these conditions in the postoperative period. There were no deaths and all were discharged. The late evolution goes from 20 days to 10 months with one death occurred after 4 months due to sepsis.Conclusion: This method, besides reducing the ischemic time of the procedure, allows the donated organ to regain and maintain their beats without pre or after load during implantation entailing the physiological recovery of the graft.Descriptors: Ischemia. Heart transplantation. Cardiac surgical procedures. ResumoIntrodução e Objetivo: Trata-se do implante em posição ortotópica bicaval bipulmonar do coração doado batendo em normotermia. Este estudo busca diminuir o tempo isquêmico e criar condições de ir se adaptando ao organismo hospedeiro.Métodos: Já em CEC, a primeira anastomose a ser feita é a da aorta, reperfundindo as artérias coronárias e recuperando os batimentos. As restantes são realizadas com o coração batendo em ritmo sinusal, sendo a da artéria pulmonar a última. Esta metodologia foi aplicada em 10 pacientes receptores, sendo oito do sexo masculino, com RBCCV 44205-1331

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Warm reperfusion and myocardial protection

Cited by 21 publications

References 11 publications

Plasma Troponin Levels after Cardiac Surgery vs after Myocardial Infarction

Plasma Troponin Levels after Cardiac Surgery vs after Myocardial Infarction

Beneficial Effect of the Addition of Nitroglycerin to the Cardioplegic Solution on Lipid Peroxidation During Coronary Artery Bypass Surgery

"Non Working Beating Heart"

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