Abstract 313: Changes in Autophagic Flux in Patients Undergoing Cardiac Surgery

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Salik Jahania ◽  
David Sengstock ◽  
Peter Vaitkevicius ◽  
Redah Mahmood ◽  
Fahed Sabagh ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Cardiac Tissue ◽  
Beclin 1 ◽  
Right Atrial ◽  
Autophagic Flux ◽  
Number Of Patients ◽  
Before And After ◽  
A Prospective Study ◽  
Ischemic Stress

Autophagy is an endogenous survival mechanism and adaptive response to cellular stress. We hypothesized that autophagy plays an important cardioprotective role in humans and would be accelerated during the ischemic stress of conventional heart surgery. In a prospective study to test this hypothesis, we measured key autophagy proteins (Beclin-1, Atg5-12, p62) in cardiac tissue from 5 patients undergoing cardiac surgery. Right atrial biopsies were obtained before and after cessation of cardiopulmonary bypass (CPB). In 4 of these patients, CPB was associated with a marked decrease in cardiac Beclin-1, Atg5-12, and p62. We believe that depletion of these factors, particularly p62, reflects a brisk increase in autophagic flux (Fig. 1). In one patient (#02), autophagic flux appeared to be impaired. This occurred in an aged patient with characteristics of metabolic syndrome (MetS) who had the highest predicted operative morbidity/mortality. While the number of patients studied is small and insufficient to reach any definitive conclusions, these preliminary data confirm the feasibility of studying autophagy in the human heart and suggest that ischemic stress during heart surgery is associated with a marked upregulation of autophagic flux. A better understanding of the role of autophagy could lead to the development of new cardioprotective strategies. [Figure 1: Changes in cardiac autophagy proteins in patients undergoing heart surgery before and after cross-clamping the aorta (after restoration of myocardial blood flow).]

Abstract 110: Activation of the Homeostatic Intracellular Response Leads to Increased Myocardial Mitochondrial Turnover in Patients Undergoing Cardiac Surgery

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Allen M Andres ◽  
David Sengstock ◽  
Salik Jahania ◽  
Reza Dabir ◽  
Roberta A Gottlieb ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Protective Action ◽  
Principal Component ◽  
Beclin 1 ◽  
Right Atrial ◽  
Mitochondrial Population ◽  
Mitochondrial Turnover

Background: Previously we showed that the homeostatic intracellular repair response (HIR2) is activated in the hearts of patients undergoing cardiac surgery. Autophagy is a principal component of this beneficial response that clears fragile mitochondria and protein aggregates. Moreover, we have previously shown that mitochondrial elimination through autophagy (mitophagy) is a key element in ischemic preconditioning. Thus, an important mechanism of cardioprotection appears to involve the upregulation of autophagy which facilitates the clearance of vulnerable mitochondria to limit I/R injury. We hypothesized that this protective action leads to turnover of the existing mitochondrial population in the heart during the resolution of I/R injury. The purpose of this study was to examine if the mechanism of HIR2 extends to remodeling the existing mitochondrial population of the heart. Study Design: Autophagy and mitochondrial turnover were assessed in 10 patients undergoing coronary artery bypass or valve surgery requiring cardiopulmonary bypass. Biopsies of the right atrial appendage obtained before initiation and after weaning from cardiopulmonary bypass were processed to yield whole tissue lysates and mitochondria-enriched heavy membrane fractions. Samples were analyzed for autophagy by immunoblotting for LC3, Beclin-1, ATG5-12, and p62. Mitochondrial turnover was assessed by monitoring Tom70, Cox4, Drp1, p62 and Parkin in tissue lysates and heavy membrane fractions. Results: Heart surgery was associated with a robust increase in autophagy indicated by depletion of LC3, Beclin-1, ATG5-12 and p62, as well as the mitophagy and fission regulator Drp1. Parkin increased in the mitochondrial fraction after bypass. Surprisingly, post-bypass tissue lysates showed a marked increase in mitochondrial markers Tom70 and Cox4, suggesting mitochondrial biogenesis. Conclusions: These findings provide evidence for the first time in humans that coordinated mitophagy and biogenesis are part of the homeostatic response to I/R, pointing to the importance of studying this aspect of HIR2. Strategies designed to amplify HIR2 during cardiac stress may represent an entirely new approach to myocardial protection in patients undergoing heart surgery.

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

Intraoperative CARTO Mapping for Atrial Fibrillation Ablation in Patients Undergoing Cardiac Surgery

2021 ◽  
Author(s):  
Sara Rita Vacirca
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Atrial Fibrillation Ablation ◽  
Surgical Ablation ◽  
Before And After ◽  
The Mean ◽  
Exit Block

Objective: Intraoperative CARTO Mapping for Atrial Fibrillation ablation in cardiac surgery. Background: Surgical ablation of Atrial Fibrillation is usually performed without mapping. The study aims to determine if intraoperative CARTO can be useful to guide the ablating procedure. Methods and Findings: Fourteen patients with symptomatic and drug-refractory concomitant AF were operated on in 2003 and 2004. CARTO mapping was performed before and after surgical bipolar radio-frequency ablation. Application of energy was repeated when residual electrical activity was detected at the pulmonary veins-atrial junction. Pacing wires were applied on right and left pulmonary veins distally to the ablation line to confirm the exit block. The mapping protocol was completed in 12 patients. Acute left atrium-pulmonary vein isolation was achieved after single or double energy application in 2/12 (16.6%) and 9/12 (75%) patients, respectively. The mean duration of the mapping and ablation procedure was 67 minutes. At discharge, PV isolation persisted in 10 patients: exit block was confirmed by the absence of pacing through the pulmonary veins electrodes. After a mean follows up of 181 months, no further recurrent AF events were registered in 9/12 (69.2%) patients. Conclusions: CARTO system is useful during open-heart surgery to guide the ablating strategy.

Perioperative management of the high-risk surgical patient: cardiac surgery

2017 ◽  
Author(s):  
Marco Ranucci ◽  
Serenella Castelvecchio ◽  
Andrea Ballotta
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
High Risk Patient ◽  
Advanced Age ◽  
Bleeding Complications ◽  
Surgical Patient ◽  
Number Of Patients

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.

scholarly journals Early Postoperative Arrhythmias after Paediatric Cardiac Surgery

2018 ◽  
Vol 6 (1) ◽  
pp. 22-28
Author(s):  
Kazi Zahidul Hoque ◽  
Akhand Tanzih Sultana ◽  
Mamun Mia ◽  
Masumul Gani Chowdhury ◽  
Makbul Hossein
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Cardiac Surgery ◽  
Postoperative Period ◽  
Significant Risk ◽  
Radical Change ◽  
Paediatric Cardiac Surgery ◽  
Number Of Patients ◽  
Paediatric Age ◽  
A Prospective Study

Background: The radical change in techniques in paediatric cardiac surgery has dramatically reduced the morbidity and mortality. The different varieties of arrhythmia that are frequently observed in postoperative period in our country are still not well documented.Objectives: To determine the incidence and risk factors of arrhythmia immediately after cardiac surgery in paediatric age group.Materials and method: It was a prospective study. A total of 100 paediatric patients (age <18 years) who underwent cardiac surgery at Dhaka Shishu Hospital between 2013 and 2016 were selected purposivelyResults: Out of 100 patients maximum 41% were from 13-72 months age group. The mean age was 49.73±37.17 months with range of 0.5-231 months, 58% patients were male and rest were female. Postoperatively 31% subjects were arrhythmic and of these the highest number of patients suffered from junctional ectopic tachycardia. Out of these 100 patients, 39% were diagnosed as VSD followed by TOF (35%). Among 31 arrhythmic patients 59.83%, 41.93% and 3.22% manifested onset of arrhythmia at 1st, 1st to 2nd and 2nd to 7th postoperative period respectively. In this study age, body weight, cyanosis, CPB time, postoperative acidosis, ventilation support days, hypertension on arrival in ICU as well as ICU stay days were recognized as significant risk factors (p <0.05).Conclusion: Proper and careful monitoring of younger patient with lower body weight undergoing corrective cardiac surgery with long cardiopulmonary bypass (CPB) time may reduce the episodes of post operative arrhythmia. These patients may require high inotropic support post operatively. So, medical prevention and early diagnosis as well as proper management may improve the operative outcome.Delta Med Col J. Jan 2018 6(1): 22-28

scholarly journals Respiratory mechanics behavior after heart surgery: an experimental study

2021 ◽  
Vol 43 ◽  
pp. e55460
Author(s):  
Francisco José Nascimento Lima ◽  
Katia de Miranda Avena ◽  
Helder Brito Duarte ◽  
Kristine Menezes Barberino Mendes ◽  
Yasmin Silva Gomes ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Minute Volume ◽  
Pulmonary Complications ◽  
Ventilatory Parameters ◽  
Significant Damage ◽  
Before And After ◽  
Recorded Data ◽  
Ventilatory Mechanics ◽  
The City

Changes in ventilatory mechanics and their consequent pulmonary complications are common after surgical procedures, particularly in cardiac surgery (CS), and may be associated with both preoperative history and surgical circumstances. This study aims to compare ventilatory mechanics in the moments before and after cardiac surgery (CS), describing how pulmonary complications occurred. An experimental, uncontrolled study was conducted, of the before-and-after type, and with a descriptive and analytical character. It was carried out in a private hospital in the city of Salvador, Bahia, Brazil, and involved 30 adult patients subjected to CS. In addition to clinical and epidemiological variables, minute volume (VE), respiratory rate (RR), tidal volume (VT), forced vital capacity (FVC), maximum inspiratory pressure (MIP), and peak expiratory flow (PEF) were also recorded. Data were collected in the following moments: preoperative (PRE-OP) period, immediate postoperative (IPO) period, and 1st postoperative day (1st POD). The sample was aged 48.1 ± 11.8 years old and had a body mass index of 25.5 ± 4.9 kg m-2; 60% of the patients remained on mechanical ventilation for less than 24 hours (17.5 [8.7-22.9] hours).  There was a significant reduction in VT, FVC, MIP and PEF when PRE-OP versus IPO, and PRE-OP versus 1st POD were compared (p < 0.05). There were no significant changes between IPO and the 1st POD. The highest incidence of pulmonary complications involved pleural effusion (50% of the patients). This study showed that patients subjected to CS present significant damage to ventilatory parameters after the surgery, especially in the IPO period and on the 1st POD. It is possible that the extension of this ventilatory impairment has led to the onset of postoperative pulmonary complications.

Perioperative management of the high-risk surgical patient: cardiac surgery

2016 ◽  
Author(s):  
Marco Ranucci ◽  
Serenella Castelvecchio ◽  
Andrea Ballotta
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
High Risk Patient ◽  
Advanced Age ◽  
Bleeding Complications ◽  
Surgical Patient ◽  
Number Of Patients

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.

scholarly journals Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alessandro Varrica ◽  
Angela Satriano ◽  
Alessandro Frigiola ◽  
Alessandro Giamberti ◽  
Guido Tettamanti ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Neurological Disorders ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Serum Levels ◽  
S100b Protein ◽  
Perioperative Monitoring ◽  
A Prospective Study

Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD) newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB), has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels.Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN) measurement were drawn at five perioperative time-points.Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak(P<0.01)during CPB and at the end of the surgical procedure. Moreover, ADN showed a flat pattern and no significant differences(P>0.05)have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery.Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

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