scholarly journals Endothelial glycocalyx during early reperfusion in patients undergoing cardiac surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251747
Author(s):  
Arie Passov ◽  
Alexey Schramko ◽  
Ulla-Stina Salminen ◽  
Juha Aittomäki ◽  
Sture Andersson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heparan Sulfate ◽  
Coronary Sinus ◽  
Heart Surgery ◽  
Coronary Circulation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Open Heart Surgery ◽  
Endothelial Glycocalyx ◽  
Early Reperfusion

Background Experimental cardiac ischemia-reperfusion injury causes degradation of the glycocalyx and coronary washout of its components syndecan-1 and heparan sulfate. Systemic elevation of syndecan-1 and heparan sulfate is well described in cardiac surgery. Still, the events during immediate reperfusion after aortic declamping are unknown both in the systemic and in the coronary circulation. Methods In thirty patients undergoing aortic valve replacement, arterial concentrations of syndecan-1 and heparan sulfate were measured immediately before and at one, five and ten minutes after aortic declamping (reperfusion). Parallel blood samples were drawn from the coronary sinus to calculate trans-coronary gradients (coronary sinus–artery). Results Compared with immediately before aortic declamping, arterial syndecan-1 increased by 18% [253.8 (151.6–372.0) ng/ml vs. 299.1 (172.0–713.7) ng/ml, p < 0.001] but arterial heparan sulfate decreased by 14% [148.1 (135.7–161.7) ng/ml vs. 128.0 (119.0–138.2) ng/ml, p < 0.001] at one minute after aortic declamping. There was no coronary washout of syndecan-1 or heparan sulfate during reperfusion. On the contrary, trans-coronary sequestration of syndecan-1 occurred at five [-12.96 ng/ml (-36.38–5.15), p = 0.007] and at ten minutes [-12.37 ng/ml (-31.80–6.62), p = 0.049] after reperfusion. Conclusions Aortic declamping resulted in extracardiac syndecan-1 release and extracardiac heparan sulfate sequestration. Syndecan-1 was sequestered in the coronary circulation during early reperfusion. Glycocalyx has been shown to degrade during cardiac surgery. Besides degradation, glycocalyx has propensity for regeneration. The present results of syndecan-1 and heparan sulfate sequestration may reflect endogenous restoration of the damaged glycocalyx in open heart surgery.

scholarly journals Markers of endothelial dysfunction after cardiac surgery: Soluble forms of vascular-1 and intercellular-1 adhesion molecules

Medicina ◽  
2009 ◽  
Vol 45 (6) ◽  
pp. 434 ◽  
Author(s):  
Mindaugas Balčiūnas ◽  
Loreta Bagdonaitė ◽  
Robertas Samalavičius ◽  
Alis Baublys
Keyword(s):  
Cardiac Surgery ◽  
Endothelial Dysfunction ◽  
Reperfusion Injury ◽  
Adhesion Molecules ◽  
Heart Surgery ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Transplant Rejection ◽  
Vascular Wall ◽  
Tissue Ischemia

Endothelium forms an inner layer of vascular wall. It plays an important role in inflammatory process, regulation of vascular tone, and synthesis of thromboregulatory substances. Leukocyte and endothelium interactions during inflammation are regulated by different families of adhesion molecules. Increased levels of soluble forms of adhesion molecules have been detected in the circulating blood in conditions such as autoimmune diseases, transplant rejection, ischemia-reperfusion injury in addition to neutrophil- and endothelial membrane-bound forms reflecting the level of endothelial dysfunction. It is known that endothelial dysfunction is a risk factor for ischemic events such as stroke, myocardial infarction, unstable angina pectoris, ventricle fibrillation, necessity of revascularisation procedures, and death from cardiovascular reasons. Clinical studies showed that cardiac surgery has an impact on vascular endothelial function as well. The amount of endotheliumderived soluble forms of vascular-1 and intercellular-1 adhesion molecules increases after cardiopulmonary bypass suggesting endothelial dysfunction. However, further investigations are needed to be done to support the evidence that endothelial dysfunction proceeding heart surgery is one of the reasons of tissue ischemia-reperfusion injury.

scholarly journals Effect of Myocardial Ischaemia-reperfusion on Granulocyte Elastase Release

1992 ◽  
Vol 20 (2) ◽  
pp. 187-190 ◽  
Author(s):  
P. Ceriana
Keyword(s):  
Cardiopulmonary Bypass ◽  
Radial Artery ◽  
Coronary Sinus ◽  
Leucocyte Count ◽  
Heart Surgery ◽  
Coronary Circulation ◽  
Open Heart Surgery ◽  
Neutrophil Granulocytes ◽  
Aortic Cross Clamp ◽  
Granulocyte Elastase

During extracorporeal circulation, activation and degranulation of neutrophil granulocytes occur, with subsequent massive release of elastase, a neutral protease stored in the azurophil granules. Neutrophil granulocytes and oxygen-derived free radicals are intimately involved in the occurrence of reperfusion injury, which affects especially the lungs and the myocardium. In this study we evaluated changes in the leucocyte count and of the plasma elastase levels in the coronary circulation during open heart surgery. We collected blood samples from the radial artery and the coronary sinus before skin incision, after onset of cardiopulmonary bypass and 5, 15, 30, 60, 120 minutes after the release of the aortic cross-clamp. The leucocyte count did not change significantly during the operation and no difference in leucocyte count was found between the radial artery and the coronary sinus. Plasma elastase levels significantly increased after the onset of cardiopulmonary bypass (P = 0.007) and after the release of the aortic cross-clamp (P = 0.001). Moreover, significantly higher values were found in the coronary sinus than in the radial artery 5 (P = 0.04), 15 (P = 0.02) and 30 (P = 0.02) minutes after the release of the aortic cross-clamp. We assume, therefore, that during the early phase of reperfusion, degranulation of neutrophil granulocytes occurs in the coronary circulation.

scholarly journals Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Andreas Habertheuer ◽  
Alfred Kocher ◽  
Günther Laufer ◽  
Martin Andreas ◽  
Wilson Y. Szeto ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Functional Recovery ◽  
Heart Surgery ◽  
Current Practice ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Clinical Routine ◽  
High Potassium ◽  
Protective Strategies ◽  
Cardioplegic Solutions

The idea of protecting the heart from ischemic insult during heart surgery to allow elective cardiac arrest is as old as the idea of cardiac surgery itself. The current gold standard in clinical routine is a high potassium regimen added either to crystalloid or blood cardioplegic solutions inducing depolarized arrest. Ongoing patient demographic changes with increasingly older, comorbidly ill patients and increasing case complexity with increasingly structurally abnormal hearts as morphological correlate paired with evolutions in pediatric cardiac surgery allowing more complex procedures than ever beforeredefine requirements for cardioprotection. Many, in part adversarial, regimens to protect the myocardium from ischemic insults have entered clinical routine; however, functional recovery of the heart is still often impaired due to perfusion injury. Myocardial reperfusion damage is a key determinant of postoperative organ functional recovery, morbidity, and mortality in adult and pediatric patients. There is a discrepancy between what current protective strategies are capable of and what they are expected to do in a rapidly changing cardiac surgery community. An increased understanding of the molecular players of ischemia reperfusion injury offers potential seeds for new cardioprotective regimens and may further displace boundaries of what is technically feasible.

Clastogenic factor in ischemia-reperfusion injury during open-heart surgery: Protective effect of allopurinol

1995 ◽  
Vol 60 (3) ◽  
pp. 736-737 ◽  
Author(s):  
Ingrid Emerit ◽  
Jean-Noël Fabiani ◽  
Olivier Ponzio ◽  
Andrew Murday ◽  
Françoise Lunel ◽  
...  
Keyword(s):  
Protective Effect ◽  
Reperfusion Injury ◽  
Heart Surgery ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Open Heart Surgery ◽  
Open Heart

scholarly journals Effect of Iloprost, a Prostacyclin Analogue, on Myocardial Ischemia- Reperfusion Injury

2019 ◽  
Vol 22 (1) ◽  
pp. E027-E031 ◽  
Author(s):  
Naim Boran Tumer ◽  
Gokhan Erol ◽  
Atike Tekeli Kunt ◽  
Suat Doganci
Keyword(s):  
Myocardial Ischemia ◽  
Reperfusion Injury ◽  
Heart Surgery ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Open Heart Surgery ◽  
Prostacyclin Analogue ◽  
Myocardial Ischemia Reperfusion Injury ◽  
Myocardial Ischemia Reperfusion ◽  
Experimental Group

Myocardial ischemia-reperfusion injury continues to be observed during open heart surgery. Various experimental models have been developed to overcome this injury and to increase postoperative prognosis. This study was conducted to assess the effect that iloprost, a prostacyclin analogue, can have on myocardial ischemia-reperfusion injury. We evaluated tissue damage by measuring the levels of malonyldialdehyde (MDA), glutathione, and nitric oxide (NO) in tissue and perfusates. In this study, 20 guinea pig hearts were prepared by using the modified Langendorff perfusion apparatus to form control (n = 10) and experimental study groups (n = 10). Following a preischemic period of perfusion and an ischemic period of 20 minutes, control hearts were perfused with Krebs–Henseleit solution. In the experimental group, iloprost (0.45 µg/kg per hour) was included in the perfusates for the last 10 minutes of the preischemic phase. Following cardiac stabilization, heart rate (pulse/min), contractility (mm), and aortic pressure (mmHg) values were recorded at the end of preischemia, postischemia, and reperfusion. Perfusate and tissue analyses for glutathione, MDA, and NO levels were made in each group at the end of experiments. Iloprost was found to have protective effects against myocardial ischemia by means of increased myocardial contractility, decreased tissue/perfusate glutathione levels and inhibited rise of tissue/perfusate MDA observed in the iloprost-treated experimental group. Future investigations on myocardial ischemia-reperfusion injury must evaluate iloprost-related mechanisms.

scholarly journals Coronary Sinus Lactate as Marker of Myocardial Ischemia in Cardiac Surgery: Correlation with Morbidity and Mortality after Cardiac Surgery / Lactatul din sinusul coronarian - marker al ischemiei miocardice în chirurgia cardiacă: corelaţii cu morbiditatea şi mortalitatea postoperatorie

2015 ◽  
Vol 23 (2) ◽  
Author(s):  
Victor Raicea ◽  
Judit Kovacs ◽  
Liviu Moraru ◽  
Horatiu Suciu
Keyword(s):  
Cardiac Surgery ◽  
Coronary Sinus ◽  
Lactate Level ◽  
Heart Surgery ◽  
Contractile Function ◽  
Open Heart Surgery ◽  
Morbidity And Mortality ◽  
Rapid Decline ◽  
Open Heart ◽  
Lactate Levels

AbstractIntroduction. Perioperative myocardial injuries are one of the most frequent causes of morbidity and mortality after cardiac surgery, the most common etiology being the poor myocardial protection during aortic crossclamp. During aortic crossclamp progressive accumulation of lactate and intracellular acidosis are well-known phenomena, and are associated with alteration of myocardial contractile function. Our objective was to study the coronary sinus lactate levels as a predictor of postoperative hemodynamic outcome in open-heart surgical patients.Material and methods. We performed a prospective clinical trial, including 142 adult patients with elective cardiac surgery. Anterograde cardioplegia was administered in 82 patients, retrograde cardioplegia in 60 (in 30 patients it was administrated intermittently and in 30 continuously). Blood was collected simultaneously from the aortic cardioplegic line (inflow) and from coronary sinus or the aortic root (outflow) before aortic crossclamp, after crossclamp at every 10 minutes and after crossclamp removal at 0 and 10 minutes. All patients were operated on cardiopulmonary bypass with cardiac arrest, using warm-blood cardioplegia for cardioprotection.Results. Lactate levels showed increasing values during aortic crossclamp, and a rapid decline after crossclamp removal. The incidence of low cardiac output was significantly higher in patients with lactate levels that exceeded 4 mmol/L. In patients who died in the postoperative period, lactate level was even higher (5 mmol/L), with only a modest recovery after crossclamp removal.Conclusion. Monitoring lactate level in coronary sinus blood is a reliable method and has a good prognostic value regarding postoperative morbidity and mortality in open heart surgery

Pulmonary Protection During Cardiac Surgery: Systematic Literature Review

2008 ◽  
Vol 16 (6) ◽  
pp. 503-507 ◽  
Author(s):  
Enisa MF Carvalho ◽  
Edmo A Gabriel ◽  
Tomas A Salerno
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Literature Review ◽  
Heart Surgery ◽  
Ischemia Reperfusion Injury ◽  
Current Knowledge ◽  
Ischemia Reperfusion ◽  
Pulmonary Dysfunction ◽  
Pulmonary Protection ◽  
Postoperative Pulmonary Dysfunction

Ischemia-reperfusion injury occurs during heart surgery in which cardiopulmonary bypass is used. Current knowledge of the factors contributing to postoperative pulmonary dysfunction and the measures to avoid it are reviewed.

Sign in / Sign up

Export Citation Format

Share Document