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Banerjee D, Feng J, Sellke FW. Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass. Front Surg 2024; 11:1224068. [PMID: 39022594 PMCID: PMC11251955 DOI: 10.3389/fsurg.2024.1224068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
Cardiopulmonary bypass (CPB) initiates an intense inflammatory response due to various factors: conversion from pulsatile to laminar flow, cold cardioplegia, surgical trauma, endotoxemia, ischemia-reperfusion injury, oxidative stress, hypothermia, and contact activation of cells by the extracorporeal circuit. Redundant and overlapping inflammatory cascades amplify the initial response to produce a systemic inflammatory response, heightened by coincident activation of coagulation and fibrinolytic pathways. When unchecked, this inflammatory response can become maladaptive and lead to serious postoperative complications. Concerted research efforts have been made to identify technical refinements and pharmacologic interventions that appropriately attenuate the inflammatory response and ultimately translate to improved clinical outcomes. Surface modification of the extracorporeal circuit to increase biocompatibility, miniaturized circuits with sheer resistance, filtration techniques, and minimally invasive approaches have improved clinical outcomes in specific populations. Pharmacologic adjuncts, including aprotinin, steroids, monoclonal antibodies, and free radical scavengers, show real promise. A multimodal approach incorporating technical, circuit-specific, and pharmacologic strategies will likely yield maximal clinical benefit.
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Affiliation(s)
| | | | - Frank W. Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Brown University/Rhode Island Hospital, Providence, RI, United States
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Oxidative stress and related metabolic alterations are induced in ex situ perfusion of donated hearts regardless of the ventricular load or leukocyte depletion. Am J Transplant 2023; 23:475-483. [PMID: 36695686 DOI: 10.1016/j.ajt.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 01/05/2023]
Abstract
We sought to determine the role of donor blood circulating leukocytes in mediating oxidative stress and inflammation during normothermic ex situ heart perfusion (ESHP). Normothermic ESHP allows preservation of donated heart in a perfused, dynamic state, preventing ischemia. However, the cardiac function declines during ESHP, limiting the potential of this method for improvement of the outcomes of transplantation and expanding the donor pool. Extracorporeal circulation-related oxidative stress plays a critical role in the functional decline of the donor heart. Hearts from domestic pigs were perfused in working mode (WM, whole blood-based or leukocyte-depleted blood-based perfusate) or nonworking mode. Markers of oxidative stress and responsive glucose anabolic pathways were induced in the myocardium regardless of left ventricular load. Myocardial function during ESHP as well as cardioprotective mechanisms were preserved better in WM. Leukocyte-depleted perfusate did not attenuate tissue oxidative stress or perfusate proinflammatory cytokines and did not improve functional preservation. Although ESHP is associated with ongoing oxidative stress and metabolic alteration in the myocardium, preserved cardioprotective mechanisms in WM may exert beneficial effects. Leukocyte depletion of the perfusate may not attenuate inflammation and oxidative stress effectively or improve the functional preservation of the heart during ESHP.
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Luo ZR, Yu LL, Zheng GZ, Huang ZY. Myocardial injury and inflammatory response in percutaneous device closures of pediatric patent ductus arteriosus. BMC Cardiovasc Disord 2022; 22:228. [PMID: 35585489 PMCID: PMC9118593 DOI: 10.1186/s12872-022-02666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background The percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic inflammatory markers’ levels after PDA in children are not fully reported. Methods We have conducted a retrospective analysis of the medical records of 385 pediatric patients in our hospital from January 2017 to December 2019. The patients were distributed into five groups. The first four (A, B, C and D) included patients divided by the type of the surgical closure methods, namely ligation, clamping, ligation-combined suturing and ligation-combined clamping, respectively. The fifth group E comprised of percutaneous device PDA patients. All recorded medical and trial data from the five groups were statistically studied. Results No serious complications in the patients regardless of the classification group were reported. Our results suggested that there were no considerable differences between the groups at the baseline (with all P > 0.05). Group E demonstrated a significantly smaller operative time (42.39 ± 3.88, min) and length of hospital stay (LOS) (4.49 ± 0.50, day), less intraoperative blood loss (7.12 ± 2.09, ml) while on the other hand, a higher total hospital cost (24,001.35 ± 1152.80, RMB) than the other four groups (with all P < 0.001). Interestingly, the comparison of the inflammatory factors such as white blood cells (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), as well as the myocardial injury markers (CKMB and troponin I) did not show a significant increase (P > 0.05) among the four groups. On the contrary, when the aforementioned factors and markers of all the surgical groups were compared to those in group E, we observed significantly higher speed and magnitude of changes in group E than those in groups A, B, C, and D (with all P < 0.001). Conclusion Although the percutaneous device closure of PDA is more comforting and drives fast recuperation in comparison to conventional surgery, it provokes myocardial injury and overall inflammation. Timely substantial and aggressive intervention measures such as the use of antibiotics before operation and active glucocorticoids to suppress inflammation and nourish the myocardium need be applied if the myocardial and inflammatory markers are eminent.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Ling-Li Yu
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Guo-Zhong Zheng
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Zhong-Yao Huang
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China.
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Tessema B, Sack U, Serebrovska Z, König B, Egorov E. Effects of Hyperoxia on Aging Biomarkers: A Systematic Review. FRONTIERS IN AGING 2022; 2:783144. [PMID: 35822043 PMCID: PMC9261365 DOI: 10.3389/fragi.2021.783144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022]
Abstract
The effects of short-term hyperoxia on age-related diseases and aging biomarkers have been reported in animal and human experiments using different protocols; however, the findings of the studies remain conflicting. In this systematic review, we summarized the existing reports in the effects of short-term hyperoxia on age-related diseases, hypoxia-inducible factor 1α (HIF-1α), and other oxygen-sensitive transcription factors relevant to aging, telomere length, cellular senescence, and its side effects. This review was done as described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A systematic search was done in PubMed, Google Scholar, and Cochrane Library and from the references of selected articles to identify relevant studies until May 2021. Of the total 1,699 identified studies, 17 were included in this review. Most of the studies have shown significant effects of short-term hyperoxia on age-related diseases and aging biomarkers. The findings of the studies suggest the potential benefits of short-term hyperoxia in several clinical applications such as for patients undergoing stressful operations, restoration of cognitive function, and the treatment of severe traumatic brain injury. Short-term hyperoxia has significant effects in upregulation or downregulation of transcription factors relevant to aging such as HIF-1α, nuclear factor kappa-light-chain-enhancer of activated B-cells (NF-kB), and nuclear factor (erythroid-derived 2)-like 2 (NRF2) among others. Short-term hyperoxia also has significant effects to increase antioxidant enzymes, and increase telomere length and clearance of senescent cells. Some of the studies have also reported adverse consequences including mitochondrial DNA damage and nuclear cataract formation depending on the dose and duration of oxygen exposure. In conclusion, short-term hyperoxia could be a feasible treatment option to treat age-related disease and to slow aging because of its ability to increase antioxidant enzymes, significantly increase telomere length and clearance of senescent cells, and improve cognitive function, among others. The reported side effects of hyperoxia vary depending on the dose and duration of exposure. Therefore, it seems that additional studies for better understanding the beneficial effects of short-term hyperoxia and for minimizing side effects are necessary for optimal clinical application.
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Affiliation(s)
- Belay Tessema
- Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Faculty of Medicine, University of Leipzig, Leipzig, Germany
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ulrich Sack
- Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Zoya Serebrovska
- Department of Hypoxic States Investigation, Bogomoletz Institute of Physiology of National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Brigitte König
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Egor Egorov
- Ipam Institute for Preventive and Anti-Aging Medicine, Berlin, Germany
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Hong ZN, Huang JS, Sun KP, Luo ZR, Chen Q. Comparison of Postoperative Changes in Inflammatory Marker Levels Between Transthoracic and Transcatheter Device Closures of Atrial Septal Defects in Children. Braz J Cardiovasc Surg 2020; 35:498-503. [PMID: 32864930 PMCID: PMC7454624 DOI: 10.21470/1678-9741-2019-0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the postoperative changes in inflammatory markers in children who underwent device closure of an atrial septal defect (ASD) via a transthoracic or transcatheter approach. Methods The experimental and clinical data were retrospectively collected and analyzed for a total of 53 pediatric patients between September 2018 and December 2018. According to the different treatments, 19 patients who underwent transthoracic device closure were assigned to group A, and the remaining 34 patients who underwent a transcatheter approach were assigned to group B. Results All patients were successfully occluded without any device-related severe complication. Compared with the preoperative levels, the postoperative levels of most inflammatory cytokines in both groups were significantly increased and reached a peak on the first day after the procedure. The level of postoperative inflammatory cytokines was significantly lower in group B than in group A. In addition, there was no significant difference in procalcitonin before and after the transcatheter approach. Conclusion Systemic inflammatory reactions occurred after transthoracic or transcatheter device closure of ASDs in pediatric patients. However, these inflammatory reactions were more significant in patients who underwent a transthoracic approach than in patients who underwent a transcatheter approach.
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Affiliation(s)
- Zhi-Nuan Hong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jiang-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Kai-Peng Sun
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Zeng-Rong Luo
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
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Li J, Yang L, Wang G, Wang Y, Wang C, Shi S. Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest. J Cardiothorac Surg 2019; 14:217. [PMID: 31842939 PMCID: PMC6916067 DOI: 10.1186/s13019-019-1027-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background This cohort study aims to retrospectively investigate the incidence of severe systemic inflammatory response syndrome (sSIRS) in patients following total aortic arch replacement (TAR) under deep hypothermic circulatory arrest (DHCA) with selective cerebral perfusion and its effect on clinical outcomes. Methods All patients who underwent TAR with DHCA were consecutively enrolled from January 2013 until December 2015 at our institute. sSIRS was diagnosed between 12 and 48 h postoperatively if patients met all four criteria of the SIRS definition. Results Of the 522 patients undergoing TAR with DHCA, 31.4% developed sSIRS. Patients aged under 60 yr were characterized by a higher prevalence of sSIRS (OR = 2.93; 95% CI 2.01–4.28; P <0.001). Higher baseline serum creatinine (OR = 1.61; 95% CI 1.18–2.20; P = 0.003), concomitant coronary disease (OR = 2.00; 95% CI 1.15–3.48; P = 0.015) and extended cardiopulmonary time (OR = 1.63; 95% CI 1.23–2.18; P = 0.001) independently contributed to a greater likelihood of postoperative sSIRS onset, while the preferred administration of ulinastatin (OR = 0.69; 95% CI 0.51–0.93; P = 0.015) and dexmedetomidine (OR = 0.36; 95% CI 0.23–0.56; P < 0.001) attenuated it. Patients with sSIRS had a greater risk of developing postoperative major adverse complications compared with the no sSIRS group [56.7%(93/164) vs 26.8% (96/358), P < 0.001]. sSIRS was found to be a significant risk factor for major adverse complications (OR, 4.52; 95% CI, 3.40–6.01; P < 0.001). A significant difference was revealed in in-hospital death following TAR between the sSIRS group and the no-sSIRS group [4.88% (8/164) vs 1.12% (4/358), P = 0.019]. The Kaplan-Meier curve indicated that the time to discharge from the intensive care unit was significantly prolonged in the sSIRS group compared with patients without it (log-rank p < 0.001). Conclusions sSIRS occurs commonly in patients following TAR with DHCA. There is an inverse association between age and sSIRS onset, whereby age over 60 yr can lower the risk of it. sSIRS development can increase the likelihood of major postoperative major adverse events.
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Affiliation(s)
- Jun Li
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Belishi road 167, Xicheng District, Beijing, 100037, China
| | - Lijing Yang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Belishi road 167, Xicheng District, Beijing, 100037, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yuefu Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Belishi road 167, Xicheng District, Beijing, 100037, China.
| | - Chunrong Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Belishi road 167, Xicheng District, Beijing, 100037, China
| | - Sheng Shi
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Belishi road 167, Xicheng District, Beijing, 100037, China
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Abqari S, Kappanayil M, Sudhakar A, Balachandran R, Nair SG, Kumar RK. Common inflammatory markers after cardiac surgery in infants and their relation to blood stream sepsis. Heliyon 2019; 5:e02841. [PMID: 31768439 PMCID: PMC6872838 DOI: 10.1016/j.heliyon.2019.e02841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/15/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023] Open
Abstract
Background Limited information exists on trends of common inflammatory markers after infant heart surgery and their role in identifying post-operative sepsis. Methods 275 consecutive infants undergoing cardiac surgery (231 with and 44 without Cardiopulmonary Bypass) were studied prospectively. Daily trends (0-4 day post-operative) of leucocyte counts, platelet counts and C-reactive protein were recorded. Association of these trends with early post-operative bloodstream sepsis, Cardiopulmonary Bypass and surgical outcomes were studied. Observations Trends of these inflammatory markers were noted. While off-Cardiopulmonary Bypass Surgery, and sepsis were associated with a statisticaly insignificant rise in total leucocyte count peaking on first post-operative day, Cardiopulmonary Bypass exposure was associated with significant decline (p = 0.002), more pronounced with Cardiopulmonary Bypass-exposure exceeding 150 min. Percentage of neutrophils showed a rise (maximum on first post-operative day) but no significant association with sepsis or Cardiopulmonary Bypass.Platelet counts significantly declined after surgery, with nadir on 2nd POD (p < 0.001), the drop being more marked in patients operated on Cardiopulmonary Bypass (p < 0.005). Counts were significantly lower in patients exposed to >150 min Cardiopulmonary Bypass compared to those with shorter Cardiopulmonary Bypass. Septic patients had significantly lower platelet counts than uninfected patients, decline >2 SD from mean pre-operative level strongly associated with sepsis (p < 0.001).C-Reactive Protein levels rose markedly after surgery, peaking on 2nd POD; levels were significantly higher if operated on Cardiopulmonary Bypass. Cardiopulmonary Bypass >150 min was associated with lower mean C-Reactive Protein on first post-operative day, but significantly higher values on third and fourth post-operative days, as compared to Cardiopulmonary Bypass <150 min. Comparison of infected versus non-infected patients showed significantly higher mean C-Reactive Protein in the former group. Conclusion While leucocyte count, platelet count and C-Reactive Protein emerged as useful markers of post-operative inflammatory response and reaction to Cardiopulmonary Bypass, they proved unsatisfactory predictors of early post-operative sepsis.
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Affiliation(s)
- Shaad Abqari
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Mahesh Kappanayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Rakhi Balachandran
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Suresh G Nair
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
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Mita N, Kagaya S, Miyoshi S, Kuroda M. Prophylactic Effect of Amiodarone Infusion on Reperfusion Ventricular Fibrillation After Release of Aortic Cross-Clamp in Patients with Left Ventricular Hypertrophy Undergoing Aortic Valve Replacement: ARandomized Controlled Trial. J Cardiothorac Vasc Anesth 2019; 33:1205-1213. [DOI: 10.1053/j.jvca.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 01/05/2023]
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Huang JS, Chen Q, Chen LW, Kuo YR, Hong ZN, Cao H. Changes in the levels of inflammatory markers after transthoracic device closure of ventricular septal defects in pediatric patients. J Cardiothorac Surg 2019; 14:70. [PMID: 30961628 PMCID: PMC6454635 DOI: 10.1186/s13019-019-0900-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Transthoracic device closure of ventricular septal defect (VSD) is widely used in the clinic, especially in China. Changes in inflammatory marker levels after transthoracic device closure of VSD in pediatric patients have not been reported. METHODS We retrospectively collected clinical data for 85 pediatric patients in our hospital from September 2017 to January 2018. The patients were divided into two groups according to treatment (device group vs. surgical group). The clinical and experimental data from the two groups were statistically analyzed. RESULTS Clinical outcomes were good in all patients without any fatal complications. Similar increasing trends in inflammatory markers (white blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6)) were found in the two groups, both of which showed noticeable systemic inflammatory responses. In addition, no significant difference in the postoperative levels of inflammatory markers was observed between these two groups. CONCLUSIONS Although transthoracic device closure of VSD seems to be less traumatic and involves a quicker recovery, it also induces a systemic inflammatory response as measured by WBC count and PCT, CRP and IL-6 levels, and the altered trends in inflammatory markers were similar to those of conventional surgery under CPB.
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Affiliation(s)
- Jiang-Shan Huang
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, the Daoshan road 18, Gulou District, Fuzhou, 350001 People’s Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001 People’s Republic of China
| | - Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, 100 TzYou 1st Rd, Kaohsiung City, 80756 Taiwan
| | - Zhi-Nuan Hong
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, the Daoshan road 18, Gulou District, Fuzhou, 350001 People’s Republic of China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, the Daoshan road 18, Gulou District, Fuzhou, 350001 People’s Republic of China
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Fanning JP, See Hoe LE, Passmore MR, Barnett AG, Rolfe BE, Millar JE, Wesley AJ, Suen J, Fraser JF. Differential immunological profiles herald magnetic resonance imaging-defined perioperative cerebral infarction. Ther Adv Neurol Disord 2018; 11:1756286418759493. [PMID: 29568329 PMCID: PMC5858684 DOI: 10.1177/1756286418759493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/09/2018] [Indexed: 11/29/2022] Open
Abstract
Background: The perioperative period is associated with a high risk for human ischaemic stroke. Although inflammatory mechanisms are known to have an important role in cerebral infarction in the nonoperative setting, their role in modulating perioperative risk remains unclear. Methods: In this prospective case-control study, we compared 10 patients (cases) who developed magnetic resonance imaging (MRI) evidence of cerebral infarction following transcatheter aortic valve implantation with 10 patients (controls) who underwent the same procedure without neurological complication. Blood sampling was performed preoperatively (baseline) and at 24 h, 48 h and 72 h postoperatively and analysed for specific cytokines, chemokines and complement factors. Results: Baseline serum assessments identified significant differences between the two cohorts for levels of complement C3, complement C4b, granulocyte-macrophage colony-stimulating factor, interleukin-15 and macrophage inflammatory protein-1β. Longitudinal regression analysis and best-fit polynomial curves of postoperative analyte profiles identified significantly higher levels of complement C3 and matrix metalloproteinase-9, and lower levels of interferon-γ and macrophage inflammatory protein-1β levels in cases versus controls. Conclusions: These results support a potentially important role for inflammatory mechanisms in MRI-defined perioperative stroke and reveal a potentially important role for complement components in this process.
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Affiliation(s)
- Jonathon P Fanning
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland 4032, Australia
| | - Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Adrian G Barnett
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Barbara E Rolfe
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Allan J Wesley
- Metro North Hospital and Health Service District, Queensland, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Fiane KKH, Dahle G, Bendz B, Halvorsen PS, Abdelnoor M, Mollnes TE, Fosse E. Reduced inflammatory response by transcatheter, as compared to surgical aortic valve replacement. SCAND CARDIOVASC J 2017; 52:43-50. [PMID: 29233022 DOI: 10.1080/14017431.2017.1416157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The inflammatory response to on-pump cardiac surgery is well known. Systemic inflammatory response syndrome after transcatheter valve implantation (TAVI) has been reported. The objective of this study was to study the inflammatory response during TAVI, and compare with the response during surgical aortic valve replacement. METHODS Eighteen patients undergoing transcatheter implantation, either by a transfemoral (n = 9) or transaortal (n = 9) approach were compared with eighteen patients admitted for surgical replacement. Blood samples per- and postoperatively were analysed for C3bc, terminal complement complex, myeloperoxidase, macrophage inflammatory protein-1β, monocyte chemo-attractant peptide-1, eotaxin, IL-6 and troponin-T. All markers were measured at defined time points and the areas under the curve were compared. RESULTS Activation of complement, granulocytes, monocytes and eosinophils were significantly lower in the transcatheter group as compared to the surgical group (<0.01). There was no difference in generation of troponin T and IL-6. A small difference in complement activation was observed between the transfemoral and transaortal placement of TAVI. There was no significant difference in clinical outcomes between the TAVI and surgical groups. DISCUSSION Activation and release of inflammatory markers was significantly less during with TAVI as compared to SAVR, particularly for markers associated with extracorporeal circulation. TAVI and SAVR generated the same degree of IL-6 and troponin T, indicating that the burden on the myocardial tissue was the same. Clinical Trials: Gov ID: NCT03074838 Unique protocol ID: 2012/7919.
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Affiliation(s)
- Karoline K H Fiane
- a The Intervention Centre , Oslo University Hospital , Oslo , Norway.,b Faculty of Medicine , Oslo University , Oslo , Norway
| | - Gry Dahle
- b Faculty of Medicine , Oslo University , Oslo , Norway.,c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway
| | - Bjørn Bendz
- d Department of Cardiology , Oslo University Hospital , Oslo , Norway
| | | | - Michael Abdelnoor
- e Department of Biostatistics and Epidemiology , Oslo University Hospital , Oslo , Norway
| | - Tom Eirik Mollnes
- b Faculty of Medicine , Oslo University , Oslo , Norway.,f Department of Immunology , Oslo University Hospital, and K.G. Jebsen IRC, University of Oslo , Oslo , Norway.,g Research Laboratory , Nordland Hospital, Bodø, and K.G. Jebsen TREC, University of Tromsø , Bodø , Norway.,h Centre of Molecular Inflammation Research , Norwegian University of Science and Technology , Trondheim , Norway
| | - Erik Fosse
- a The Intervention Centre , Oslo University Hospital , Oslo , Norway.,b Faculty of Medicine , Oslo University , Oslo , Norway
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Abstract
BACKGROUND The incidence of cardiac injury in immediate fatalities after blunt trauma remains underestimated, and reliable diagnostic strategies are still missing. Furthermore, clinical data concerning heart-specific troponin serum levels, injury severity score (ISS), catecholamine treatment and survival of patients on admission to the hospital have rarely been interrelated so far. Therefore, the object of the present study was to identify predictive parameters for mortality in the context of blunt cardiac injury. METHODS This retrospective observational study included 173 severely injured patients with an ISS ≥25 admitted to the University Hospital of Ulm, a level 1 trauma center, during 2009-2013 . Furthermore, 83 blunt trauma victims who died before hospital admission were subjected to postmortem examination at the Institute of Legal Medicine, University of Ulm, during 2009-2014. ISS, cardiac injury and associated thoracic injuries were determined in both groups. Furthermore, in the hospitalized patients, serum troponin and IL-6 levels were measured. RESULTS Macroscopic heart injury was observed in 18 % of the patients who died at the scene and only in 1 % of the patients admitted to the hospital, indicating that macroscopic heart injury is associated with an immediate life-threatening condition. Troponin levels were elevated in 43 % of the patients after admission to the hospital. Moreover, troponin serum concentrations were significantly higher in patients treated with norepinephrine (26.4 ± 4 ng/l) and in non-survivors (84.9 ± 22.8 ng/l) compared to patients without catecholamines and survivors, respectively. CONCLUSIONS Macroscopic heart injury was 20 times more frequent in non-survivors than in survivors. Serum troponin levels correlated with mortality after multiple injury and therefore may represent a valuable prognostic marker in trauma patients.
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Sharma S, Kaur A, Sharma S. Preconditioning potential of purmorphamine: a hedgehog activator against ischaemic reperfusion injury in ovariectomised rat heart. Perfusion 2017; 33:209-218. [PMID: 29065787 DOI: 10.1177/0267659117732401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The present study was been designed to investigate the role and pharmacological potential of hedgehog in oestrogen-deficient rat heart. METHODS Oestrogen deficiency was produced in female Wistar rats by the surgical removal of both ovaries and these animals were used four weeks later. Isolated rat heart was subjected to 30 min ischaemia followed by 120 min of reperfusion (I/R). The heart was subjected to pharmacological preconditioning with the hedgehog agonist purmorphamine (1μM) and GDC-0449, a hedgehog antagonist, in the last episode of reperfusion before I/R. Myocardial infarction was assessed in terms of the increase in lactate dehydrogenase (LDH), creatinine kinase-MB (CK-MB), myeloperoxidase (MPO) level and infarct size (triphenyltetrazolium chloride staining). Immunohistochemistry analysis was done for the assessment of tumour necrosis factor (TNF)-α level in cardiac tissue. eNOS expression was estimated by rt-PCR. RESULTS Pharmacological preconditioning with purmorphamine significantly attenuated I/R-induced myocardial infarction, TNF-α, MPO level and release of LDH and CK-MB compared to the I/R control group. However, GDC-0449 prevented the ameliorative preconditioning effect of estradiol. CONCLUSION It may be concluded that the hedgehog agonist purmorphamine prevents the ovariectomised heart from ischaemic reperfusion injury.
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Affiliation(s)
- Shweta Sharma
- Department of Pharmacology, Cardiovascular Division, I.S.F College of Pharmacy, Moga, India
| | - Avileen Kaur
- Department of Pharmacology, Cardiovascular Division, I.S.F College of Pharmacy, Moga, India
| | - Saurabh Sharma
- Department of Pharmacology, Cardiovascular Division, I.S.F College of Pharmacy, Moga, India
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Toikkanen V, Rinne T, Laurikka J, Porkkala H, Tarkka M, Mennander A. Pulmonary vascular resistance index during coronary artery bypass surgery with aprotinin. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:315-320. [PMID: 28460544 DOI: 10.1080/00365513.2017.1318446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Low pulmonary vascular resistance index (PVRI) reflects favorable redundant pulmonary circulation following coronary artery bypass grafting with cardiopulmonary bypass surgery (CPB). This randomized study investigated whether aprotinin given in different modalities impacts PVRI after coronary artery bypass grafting. A total of 40 patients undergoing coronary artery bypass grafting were randomized to four groups according to aprotinin dose: (1) high dose, (2) early low dose, (3) late low dose, and (4) without aprotinin. Oxygenation index, pulmonary shunt, alveolar-arterial oxygen gradient and PVRI were determined. PVRI was calculated as the transpulmonary pressure gradient divided by cardiac index multiplied by 80. The results showed that PVRI remained relative low in all patients provided aprotinin regardless of treatment dosage; PVRI increased at 4 h after restarting ventilation after CPB in patients without aprotinin as compared with aprotinin (266 ± 137, 266 ± 115, 244 ± 86 vs. 386 ± 121, dynes-s-cm-5, respectively, p = .047). Elevated postoperative PVRI was predictive for patients without aprotinin (AUC 0.668; SE 0.40; p < .0001; CI 0.590-0.746). There were no statistical differences in oxygenation index, pulmonary shunt or alveolar-arterial oxygen gradient between the groups. In conclusion, aprotinin maintains a low PVRI in elective patients with healthy lungs during CPB. We suggest that aprotinin maintains pulmonary arterial endothelial integrity.
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Affiliation(s)
- Vesa Toikkanen
- a Department of Cardiothoracic Surgery , Heart Center, Tampere University Hospital and University of Tampere , Tampere , Finland
| | - Timo Rinne
- b Division of Cardiac Anesthesia , Heart Center, Tampere University Hospital , Tampere , Finland
| | - Jari Laurikka
- a Department of Cardiothoracic Surgery , Heart Center, Tampere University Hospital and University of Tampere , Tampere , Finland
| | - Helena Porkkala
- b Division of Cardiac Anesthesia , Heart Center, Tampere University Hospital , Tampere , Finland
| | - Matti Tarkka
- a Department of Cardiothoracic Surgery , Heart Center, Tampere University Hospital and University of Tampere , Tampere , Finland
| | - Ari Mennander
- a Department of Cardiothoracic Surgery , Heart Center, Tampere University Hospital and University of Tampere , Tampere , Finland
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15
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Orosomucoid as prognosis factor associated with inflammation in acute or nutritional status in chronic heart failure. Int J Cardiol 2016; 228:488-494. [PMID: 27875723 DOI: 10.1016/j.ijcard.2016.11.134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammation and nutritional state are involved in the pathogenesis of heart failure (HF). OBJECTIVE To study the contribution of alpha-1-acid-glycoprotein (AGP) to these factors and its prognostic value in acute (AHF) or chronic HF (CHF). METHODS The observational study has included 147 patients (mean age 70years, 62% men) admitted to a cardiology department for HF and followed-up for an average 326.6±140.8days. Blood AGP values were measured by Enzyme-Linked ImmunoSorbent Assay. Monocytes subsets were determined with CD14 and CD16 antibodies by flow cytometry and body composition was measured by dual-energy X-ray absorptiometry. The regulation of tumor necrosis factor (TNF-α) and leptin by AGP in epicardial adipose tissue (EAT) were analyzed by real time polymerase chain reaction. RESULTS High AGP, that was associated with CD14+CD16+ monocytes, and proBNP levels at the discharge were indicators of rehospitalization for HF in AHF patients. However, low AGP levels determined a worse nutritional state in CHF patients. The leptin levels were downregulated by high AGP concentration in epicardial fat. CONCLUSION AGP is a dual indicator in HF because high levels are predictors of adverse outcomes in AHF but low levels are related to the worse nutritional status in CHF. The regulation of leptin by AGP in epicardial fat might suggest a new pathway as protective mechanism in CHF.
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16
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Toikkanen V, Rinne T, Nieminen R, Moilanen E, Laurikka J, Porkkala H, Tarkka M, Mennander A. The Impact of Lung Ventilation on Some Cytokines after Coronary Artery Bypass Grafting. Scand J Surg 2016; 106:87-93. [DOI: 10.1177/1457496916641340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: Cardiopulmonary bypass induces a systematic inflammatory response, which is partly understood by investigation of peripheral blood cytokine levels alone; the lungs may interfere with the net cytokine concentration. We investigated whether lung ventilation influences lung passage of some cytokines after coronary artery bypass grafting. Material and Methods: In total, 47 patients undergoing coronary artery bypass grafting were enrolled, and 37 were randomized according to the ventilation technique: (1) No-ventilation group, with intubation tube detached from the ventilator; (2) low tidal volume group, with continuous low tidal volume ventilation; and (3) continuous 10 cm H2O positive airway pressure. Ten selected patients undergoing surgery without cardiopulmonary bypass served as a referral group. Representative pulmonary and radial artery blood samples were collected for the evaluation of calculated lung passage (pulmonary/radial artery) of the pro-inflammatory cytokines (interleukin 6 and interleukin 8) and the anti-inflammatory interleukin 10 immediately after induction of anesthesia (T1), 1 h after restoring ventilation/return of flow in all grafts (T2), and 20 h after restoring ventilation/return of flow in all grafts (T3). Results: Pulmonary/radial artery interleukin 6 and pulmonary/radial artery interleukin 8 ratios ( p = 0.001 and p = 0.05, respectively) decreased, while pulmonary/radial artery interleukin 10 ratio ( p = 0.001) increased in patients without cardiopulmonary bypass as compared with patients with cardiopulmonary bypass. Conclusions: The pulmonary/radial artery equation is an innovative means for the evaluation of cytokine lung passage after coronary artery bypass grafting. The mode of lung ventilation has no impact on some cytokines after coronary artery bypass grafting in patients treated with cardiopulmonary bypass.
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Affiliation(s)
- V. Toikkanen
- Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, University of Tampere, SDSKIR, Tampere, Finland
| | - T. Rinne
- Division of Cardiac Anesthesia, Heart Center Co., Tampere University Hospital, University of Tampere, Tampere, Finland
| | - R. Nieminen
- Department of Immunopharmacology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - E. Moilanen
- Department of Immunopharmacology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - J. Laurikka
- Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, University of Tampere, SDSKIR, Tampere, Finland
| | - H. Porkkala
- Division of Cardiac Anesthesia, Heart Center Co., Tampere University Hospital, University of Tampere, Tampere, Finland
| | - M. Tarkka
- Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, University of Tampere, SDSKIR, Tampere, Finland
| | - A. Mennander
- Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, University of Tampere, SDSKIR, Tampere, Finland
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Murakami T, Iwagaki H, Saito S, Ohtani S, Kuroki K, Kuinose M, Tanaka N, Tanemoto K. Equivalence of the Acute Cytokine Surge and Myocardial Injury after Coronary Artery Bypass Grafting with and without a Novel Extracorporeal Circulation System. J Int Med Res 2016; 33:133-49. [PMID: 15790125 DOI: 10.1177/147323000503300201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiopulmonary bypass (CPB) contributes to a morbidity-inducing systemic Inflammatory response after cardiac surgery. We compared this response in patients receiving coronary artery bypass grafting (CABG) with (CPB group; n = 7) or without (off-pump group; n = 8) the Minimal Extracorporeal Circulation (MECC®) system. Serum concentrations of tumour necrosis factor (TNF)-α, soluble TNF receptors, pro- and anti-inflammatory interleukins (ILs) and other myocardial injury markers were measured after anaesthetic induction, at 1 h, 4 h and 24 h after completing all anastomoses or serially. Soluble TNF receptor type I (sTNFRI) and IL-8 peaked early after CABG in both groups and did not decline. Serum sTNFRI was significantly higher in the CPB compared with the off-pump group at 1 h, whereas IL-8 was significantly lower in the CPB group throughout. The MECC® system, therefore, produces an equivalent acute cytokine response and degree of myocardial injury to off-pump CABG, and may be useful when CABG cannot be performed without CPB.
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Affiliation(s)
- T Murakami
- Division of Cardiovascular Surgery, National Hospital Organization, Iwakuni Medical Centre, Iwakuni, Japan
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18
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Sokolowska E, Kalaska B, Miklosz J, Mogielnicki A. The toxicology of heparin reversal with protamine: past, present and future. Expert Opin Drug Metab Toxicol 2016; 12:897-909. [DOI: 10.1080/17425255.2016.1194395] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Emilia Sokolowska
- Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland
| | - Bartlomiej Kalaska
- Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Miklosz
- Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Mogielnicki
- Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland
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19
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Hilbert T, Duerr GD, Hamiko M, Frede S, Rogers L, Baumgarten G, Hoeft A, Velten M. Endothelial permeability following coronary artery bypass grafting: an observational study on the possible role of angiopoietin imbalance. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:51. [PMID: 26951111 PMCID: PMC4782352 DOI: 10.1186/s13054-016-1238-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/15/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unresolved inflammation resulting in capillary leakage with endothelial barrier dysfunction is a major contributor to postoperative morbidity and mortality after coronary artery bypass graft (CABG). Angiopoietins (ANGs) are vascular growth factors, also mediating inflammation and disruption of the endothelium, thus inducing capillary leakage. We hypothesized that changes in the relative serum levels of ANG1 and ANG2 influence endothelial barrier function and perioperative morbidity after CABG. METHODS After approval and informed consent, serum samples (n = 28) were collected pre CABG surgery, 1, 6, and 24 h after aortic de-clamping. ANG1, ANG2, soluble ANG receptor TIE2 (sTIE2), and IL-6 serum concentrations were analyzed by ELISA. Human pulmonary microvascular endothelial cells (HPMECs) were incubated with patient serum and FITC-dextran permeability was assessed. Furthermore, ANG2 secretion of HPMECs was analyzed after incubation with IL-6-containing patient serum. RESULTS CABG induced an early and sustained increase of ANG2/ANG1 ratio (5-fold after 24 h compared to pre-surgery). These changes correlated with elevated serum lactate levels, fluid balance, as well as the duration of mechanical ventilation. Permeability of HPMECs significantly increased after incubation with post-surgery serum showing a marked shift of ANG2/ANG1 balance (18-fold) compared to serum with a less pronounced increase (6-fold). Furthermore, CABG resulted in increased IL-6 serum content. Pre-incubation with serum containing high levels of IL-6 amplified the ANG2 secretion by HPMECs; however, this was not influenced by blocking IL-6. CONCLUSIONS CABG affects the balance between ANG1 and ANG2 towards a dominance of the barrier-disruptive ANG2. Our data suggest that this ANG2/ANG1 imbalance contributes to an increased postoperative endothelial permeability, likewise being reflected by the clinical course. The results strongly suggest a biological effect of altered angiopoietin balance during cardiac surgery on endothelial permeability.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Marwan Hamiko
- Department of Cardiovascular Surgery, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Lynette Rogers
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
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20
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Erdoes G, Lippuner C, Kocsis I, Schiff M, Stucki M, Carrel T, Windecker S, Eberle B, Stueber F, Book M. Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement. PLoS One 2015; 10:e0143089. [PMID: 26599610 PMCID: PMC4658107 DOI: 10.1371/journal.pone.0143089] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/14/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the periprocedural inflammatory response in patients with isolated aortic valve stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) with different technical approaches. MATERIAL AND METHODS Patients were prospectively allocated to one of the following treatments: SAVR using conventional extracorporeal circulation (CECC, n = 47) or minimized extracorporeal circulation (MECC, n = 15), or TAVI using either transapical (TA, n = 15) or transfemoral (TF, n = 24) access. Exclusion criteria included infection, pre-procedural immunosuppressive or antibiotic drug therapy and emergency indications. We investigated interleukin (IL)-6, IL-8, IL-10, human leukocyte antigen (HLA-DR), white blood cell count, high-sensitivity C-reactive protein (hs-CRP) and soluble L-selectin (sCD62L) levels before the procedure and at 4, 24, and 48 h after aortic valve replacement. Data are presented for group interaction (p-values for inter-group comparison) as determined by the Greenhouse-Geisser correction. RESULTS SAVR on CECC was associated with the highest levels of IL-8 and hs-CRP (p<0.017, and 0.007, respectively). SAVR on MECC showed the highest descent in levels of HLA-DR and sCD62L (both p<0.001) in the perioperative period. TA-TAVI showed increased intraprocedural concentration and the highest peak of IL-6 (p = 0.017). Significantly smaller changes in the inflammatory markers were observed in TF-TAVI. CONCLUSION Surgical and interventional approaches to aortic valve replacement result in inflammatory modulation which differs according to the invasiveness of the procedure. As expected, extracorporeal circulation is associated with the most marked pro-inflammatory activation, whereas TF-TAVI emerges as the approach with the most attenuated inflammatory response. Factors such as the pre-treatment patient condition and the extent of myocardial injury also significantly affect inflammatory biomarker patterns. Accordingly, TA-TAVI is to be classified not as an interventional but a true surgical procedure, with inflammatory biomarker profiles comparable to those found after SAVR. Our study could not establish an obvious link between the extent of the periprocedural inflammatory response and clinical outcome parameters.
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Affiliation(s)
- Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Lippuner
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Istvan Kocsis
- 2nd Department of Obstetrics and Gynecology, Semmelweis University of Medicine, Budapest, Hungary
| | - Marcel Schiff
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Stucki
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frank Stueber
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malte Book
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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21
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Khan R, Spagnoli V, Tardif JC, L'Allier PL. Novel anti-inflammatory therapies for the treatment of atherosclerosis. Atherosclerosis 2015; 240:497-509. [DOI: 10.1016/j.atherosclerosis.2015.04.783] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/18/2022]
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22
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Mizuno T, Kamiyama H, Mizuno M, Mizukoshi T, Shinoda A, Harada K, Uchida S, Lee JS, Kasuya A, Sawada T, Uechi M. Plasma cytokine levels in dogs undergoing cardiopulmonary bypass. Res Vet Sci 2015; 101:99-105. [PMID: 26267098 DOI: 10.1016/j.rvsc.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Currently, there are no reports of inflammatory responses to CPB in dogs. We investigated the time course of pro- and anti-inflammatory cytokine levels during and after CPB. ANIMALS The study group included 11 dogs that underwent mitral valve repair with CPB, and the control group included 7 healthy dogs that underwent ovariohysterectomy. METHODS Blood samples from the study group dogs were collected before, during and after surgery and analyzed for plasma levels of interleukin-6 (IL-6), tissue necrosis factor-α (TNF-α), interleukin-10 (IL-10), white blood cells (WBC), and C-reactive protein (CRP). Each inflammatory parameter was also compared with that of the control group dogs. RESULTS After CPB, plasma levels of IL-6, WBC counts, and CRP levels were significantly higher than preoperative levels, and IL-6 levels in the study group were significantly higher than those in the control group. CONCLUSIONS CPB induces a systemic inflammatory response in dogs.
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Affiliation(s)
- Takeshi Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Hiroshi Kamiyama
- Veterinary Cardiovascular Medicine and Surgery Unit, Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Masashi Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Takahiro Mizukoshi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Asako Shinoda
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Kayoko Harada
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Shuhei Uchida
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Joon-seok Lee
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Arane Kasuya
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Tamotsu Sawada
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Masami Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan.
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23
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Uyar IS, Onal S, Uysal A, Ozdemir U, Burma O, Bulut V. Evaluation of systemic inflammatory response in cardiovascular surgery via interleukin-6, interleukin-8, and neopterin. Heart Surg Forum 2015; 17:E13-7. [PMID: 24631985 DOI: 10.1532/hsf98.2013267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to evaluate the serum levels of interleukin-6 (IL-6), IL-8, and neopterin as a sign of systemic inflammatory response syndrome after open-heart surgery. In this study, we evaluated the influences on the levels of IL-6, IL-8, and neopterin of coronary artery bypass grafting (CABG) and valve replacement surgeries with and without the use of extracorporeal circulation (ECC). MATERIALS AND METHODS This prospective study was performed in 30 patients. In this study, we evaluated patients who underwent valve replacement surgery (group 1, n = 10), CABG with ECC (group 2, n = 10), or CABG using the beating-heart technique (group 3, n = 10). With the Human Investigation Ethics Committee consent, blood samples were obtained from the patients before the surgery (T0) and after 1 hour (T1), 4 hours (T2), 24 hours (T3), and 48 hours (T4) of protamine injection. IL-6, IL-8, and neopterin levels were measured using commercial enzyme-linked immunosorbent assay kits. RESULTS The demographic data and preoperative and operative characteristics of the patients were similar. Neopterin IL-6 and IL-8 levels significantly increased first at the fourth hour after the surgery. When compared to the levels before the surgery, this increase was statistically significant. Unlike the other 2 groups of patients, those who experienced CABG with the beating-heart technique (group 3) had decreased neopterin levels at the first hour after the surgery, but this decrease was not statistically significant. Neopterin levels increased later in the OPCAB group, but these increased levels were not as high as the neopterin levels of groups 1 and 2. Neopterin reached maximum levels at the 24th hour and, unlike groups 1 and 2, in group started to decrease at the 48th. CONCLUSIONS Complement activation, cytokine production, and related cellular responses are important factors during open-heart surgery. It is certain that ECC activates the complement systems, and activated complement proteins cause the production of several cytokines. In our study, neopterin levels in patients who underwent beating-heart method surgery were lower than those in the other groups, and these levels started to decrease at the 48th hour. These data suggest that the systemic inflammatory response was less activated in that patient group. The beating-heart method might be an important alternative in CABG surgery to minimize the complications and mortality related to surgery.
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Affiliation(s)
- Ihsan Sami Uyar
- Department of Cardiovascular Surgery, Sifa University Faculty of Medicine, Izmir, Turkey
| | - Suleyman Onal
- Department of Anesthesiology, Sifa University Faculty of Medicine, Izmir, Turkey
| | - Ayhan Uysal
- Department of Immunology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ugur Ozdemir
- Department of Cardiovascular Surgery, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Oktay Burma
- Department of Immunology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Vedat Bulut
- Department of Anesthesiology, Sifa University Faculty of Medicine, Izmir, Turkey
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Lindman BR, Goldstein JS, Nassif ME, Zajarias A, Novak E, Tibrewala A, Vatterott AM, Lawler C, Damiano RJ, Moon MR, Lawton JS, Lasala JM, Maniar HS. Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart 2015; 101:537-45. [PMID: 25605654 DOI: 10.1136/heartjnl-2014-307057] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE An inflammatory response after cardiac surgery is associated with worse clinical outcomes, but recent trials to attenuate it have been neutral. We evaluated the association between systemic inflammatory response syndrome (SIRS) and mortality after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) for aortic stenosis (AS) and evaluated whether diabetes influenced this relationship. METHODS Patients (n=747) with severe AS treated with TAVR (n=264) or SAVR (n=483) between January 2008 and December 2013 were included and 37% had diabetes mellitus. SIRS was defined by four criteria 12-48 h after aortic valve replacement (AVR): (1) white blood cell count <4 or >12; (2) heart rate >90; (3) temperature <36 or >38°C; or (4) respiratory rate >20. Severe SIRS was defined as meeting all four criteria. The primary endpoint was 6-month all-cause mortality (60 deaths occurred by 6 months). Inverse probability weighting (IPW) was performed on 44 baseline and procedural variables to minimise confounding. RESULTS Severe SIRS developed in 6% of TAVR patients and 11% of SAVR patients (p=0.02). Six-month mortality tended to be higher in those with severe SIRS (15.5%) versus those without (7.4%) (p=0.07). After adjustment, severe SIRS was associated with higher 6-month mortality (IPW adjusted HR 2.77, 95% CI 2.04 to 3.76, p<0.001). Moreover, severe SIRS was more strongly associated with increased mortality in diabetic (IPW adjusted HR 4.12, 95% CI 2.69 to 6.31, p<0.001) than non-diabetic patients (IPW adjusted HR 1.74, 95% CI 1.10 to 2.73, p=0.02) (interaction p=0.007). The adverse effect of severe SIRS on mortality was similar after TAVR and SAVR. CONCLUSIONS Severe SIRS was associated with a higher mortality after SAVR or TAVR. It occurred more commonly after SAVR and had a greater effect on mortality in diabetic patients. These findings may have implications for treatment decisions in patients with AS, may help explain differences in outcomes between different AVR approaches and identify diabetic patients as a high-risk subgroup to target in clinical trials with therapies to attenuate SIRS.
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Affiliation(s)
- Brian R Lindman
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob S Goldstein
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael E Nassif
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alan Zajarias
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anjan Tibrewala
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna M Vatterott
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cassandra Lawler
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer S Lawton
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John M Lasala
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hersh S Maniar
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Cabrera-Fuentes HA, Niemann B, Grieshaber P, Wollbrueck M, Gehron J, Preissner KT, Böning A. RNase1 as a potential mediator of remote ischaemic preconditioning for cardioprotection†. Eur J Cardiothorac Surg 2015; 48:732-7; discussion 737. [PMID: 25564211 DOI: 10.1093/ejcts/ezu519] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/26/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Remote ischaemic preconditioning (RIPC) is a non-invasive and virtually cost-free strategy for protecting the heart against acute ischaemia-reperfusion injury (IRI). We have recently shown that the inhibition of extracellular RNA (eRNA) using non-toxic RNase1 protected the heart against acute IRI, reduced myocardial infarct (MI) size and preserved left ventricular systolic function in rodent animal MI models. Based on this previous work in animals, the role of the eRNA/RNase1 system in cardiac RIPC in humans should be defined. METHODS Fourteen patients underwent cardiac surgery without RIPC; from each patient, six separate 5 ml blood specimens from radial artery and two blood specimens from coronary sinus at different time points during heart surgery were taken. Six healthy donors received RIPC (4 × 5 min upper limb ischaemia); blood parameters were quantified before and after RIPC. Twelve patients underwent cardiac surgery of which 6 received RIPC, whereas the remaining 6 were exposed to sham procedure. Circulating eRNA was quantified in plasma from arterial and coronary sinus blood obtained from patients undergoing cardiac by standard procedures. Tumour necrosis factor-α (TNF-α) production by heart tissue was assessed by enzyme-linked immuno-sorbent assay; RNase activity was quantified by an enzymatic assay. RESULTS Before surgery, eRNA levels were similar in both groups (14 ± 6 vs 13 ± 5 ng/ml; P = 0.9967). In patients without RIPC, arterial eRNA levels rose during surgery (87 ± 12 ng/ml) and peaked after (127 ± 11 ng/ml) aortic declamping; accordingly, eRNA levels in coronary sinus blood were significantly higher (206 ± 32 ng/ml; P = 0.0129) than that in radial artery. Moreover, significant elevation of TNF-α (36 ± 6 ng/ml; P = 0.0059) particularly in coronary sinus blood after opening of the aortic clamping was observed. Interestingly, applying a RIPC protocol significantly increased levels of plasma endogenous vascular RNase1 by >7-fold, and the levels of arterial (31 ± 7 ng/ml; P = 0.0024) and coronary sinus (37 ± 9 ng/ml; P < 0.0001) circulating eRNA, as well as circulating TNF-α (20 ± 4 ng/ml; P = 0.0050) levels were significantly reduced. CONCLUSIONS Upon RIPC, the level of cardioprotective RNase1 increased, while the concentration of damaging eRNA and TNF-α decreased. The present findings imply a significant contribution of the RIPC-dependent (endothelial) RNase1 for improving the outcome of cardiac surgery. However, the exact mechanism of RNase1-induced cardioprotection still remains to be explored.
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Affiliation(s)
- Hector A Cabrera-Fuentes
- Institute of Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany Department of Microbiology, Kazan Federal University, Kazan, Russian Federation
| | - Bernd Niemann
- Department of Cardiovascular Surgery, Medical School, Justus-Liebig-University, Giessen, Germany
| | - Philippe Grieshaber
- Department of Cardiovascular Surgery, Medical School, Justus-Liebig-University, Giessen, Germany
| | - Matthias Wollbrueck
- Department of Anaesthesia and Intensive Care Medicine, Medical School, Justus-Liebig-University, Giessen, Germany
| | - Johannes Gehron
- Department of Cardiovascular Surgery, Medical School, Justus-Liebig-University, Giessen, Germany
| | - Klaus T Preissner
- Institute of Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany Department of Microbiology, Kazan Federal University, Kazan, Russian Federation
| | - Andreas Böning
- Department of Cardiovascular Surgery, Medical School, Justus-Liebig-University, Giessen, Germany
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Buziashvili YI, Koksheneva IV, Samsonova NN, Abukov ST, Buziashvili VY, Klimovich LG. The dynamics of inflammatory factors in the early postoperative period after various techniques of coronary artery bypass grafting. ACTA ACUST UNITED AC 2015. [DOI: 10.17116/kardio2015814-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Tsakiridis K, Mpakas A, Kesisis G, Arikas S, Argyriou M, Siminelakis S, Zarogoulidis P, Katsikogiannis N, Kougioumtzi I, Tsiouda T, Sarika E, Katamoutou I, Zarogoulidis K. Lung inflammatory response syndrome after cardiac-operations and treatment of lornoxicam. J Thorac Dis 2014; 6 Suppl 1:S78-98. [PMID: 24672703 DOI: 10.3978/j.issn.2072-1439.2013.12.07] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/04/2013] [Indexed: 12/19/2022]
Abstract
The majority of patients survive after extracorporeal circulation without any clinically apparent deleterious effects. However, disturbances exist in various degrees sometimes, which indicate the harmful effects of cardiopulmonary bypass (CPB) in the body. Several factors during extracorporeal circulation either mechanical dependent (exposure of blood to non-biological area) or mechanical independent (surgical wounds, ischemia and reperfusion, alteration in body temperature, release of endotoxins) have been shown to trigger the inflammatory reaction of the body. The complement activation, the release of cytokines, the leukocyte activation and accumulation as well as the production of several "mediators" such as oxygen free radicals, metabolites of arachidonic acid, platelet activating factors (PAF), nitric acid, and endothelin. The investigation continues today on the three metabolites of lornoxicam (the hydroxylated metabolite and two other metabolites of unknown chemical composition) to search for potential new pharmacological properties and activities.
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Affiliation(s)
- Kosmas Tsakiridis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Andreas Mpakas
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - George Kesisis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Stamatis Arikas
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Michael Argyriou
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Stavros Siminelakis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Eirini Sarika
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Ioanna Katamoutou
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
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Jin C, Cleveland JC, Ao L, Li J, Zeng Q, Fullerton DA, Meng X. Human myocardium releases heat shock protein 27 (HSP27) after global ischemia: the proinflammatory effect of extracellular HSP27 through toll-like receptor (TLR)-2 and TLR4. Mol Med 2014; 20:280-9. [PMID: 24918749 DOI: 10.2119/molmed.2014.00058] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/07/2014] [Indexed: 12/26/2022] Open
Abstract
The myocardial inflammatory response contributes to cardiac functional injury associated with heart surgery obligating global ischemia/reperfusion (I/R). Toll-like receptors (TLRs) play an important role in the mechanism underlying myocardial I/R injury. The aim of this study was to examine the release of small constitutive heat shock proteins (HSPs) from human and mouse myocardium after global ischemia and examine the role of extracellular small HSP in myocardial injury. HSP27 release was assessed by enzyme-linked immunosorbent assay. Anti-HSP27 was applied to evaluate the role of extracellular HSP27 in the postischemic inflammatory response and functional injury in mouse hearts. Isolated hearts and cultured coronary vascular endothelial cells were exposed to recombinant HSP27 to determine its effect on proinflammatory signaling and production of proinflammatory mediators. HSP27 levels were markedly elevated in coronary sinus blood of patients and in coronary effluent of mouse hearts after global ischemia. Neutralizing extracellular HSP27 suppressed myocardial nuclear factor (NF)-κB activation and interleukin (IL)-6 production and improved cardiac function in mouse hearts. Perfusion of HSP27 to mouse hearts induced NF-κB activation and IL-6 production and depressed contractility. Further, recombinant HSP27 induced NF-κB phosphorylation and upregulated monocyte chemoattractant protein (MCP)-1 and intercellular adhesion molecule (ICAM)-1 production in both human and mouse coronary vascular endothelial cells. TLR2 knockout (KO) or TLR4 mutation abolished NF-κB phosphorylation and reduced MCP-1 and ICAM-1 production induced by extracellular HSP27 in endothelial cells. In conclusion, these results show that the myocardium releases HSP27 after global ischemia and that extracellular HSP27 is proinflammatory and contributes to the inflammatory mechanism of myocardial functional injury. Both TLR2 and TLR4 are involved in mediating the proinflammatory effect of extracellular HSP27.
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Affiliation(s)
- Chunhua Jin
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America Center for Experimental Medicine, Southern Medical University, Guangzhou, China
| | - Joseph C Cleveland
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Lihua Ao
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Jilin Li
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America Department of Cardiology, Southern Medical University, Guangzhou, China
| | - Qingchun Zeng
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America Department of Cardiology, Southern Medical University, Guangzhou, China
| | - David A Fullerton
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Xianzhong Meng
- Department of Surgery, University of Colorado Denver, Aurora, Colorado, United States of America
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Austin E, Yousif N, Ao L, Cleveland J, Fullerton D, Meng X. Ghrelin reduces myocardial injury following global ischemia and reperfusion via suppression of myocardial inflammatory response. ACTA ACUST UNITED AC 2013. [DOI: 10.18081/ajbm/2333-5106-013-12/38-48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ghrelin is a small endogenous peptide principally produced and secreted by the gastric mucosa, with a major role in appetite and metabolism regulation. We hypothesized that anti-inflammatory therapy, as produced by exogenous administration of ghrelin, would decrease the myocardial inflammatory response to global hypothermia I/R, thereby affording myocardial protection. Heterotopic cervical heart transplantation that allows to subject donor hearts to global hypothermic ischemia and blood reperfusion, which very closely stimulates I/R conditions associated with cardiac surgical operations. Ghrelin administration prior to blood reperfusion significantly decreased serum concentrations of cTn-I versus animals subjected I/R alone, with a significantly attenuated VCAM-1 expression in I/R animals pre-treated with ghrelin. The tissue concentrations of pro-inflammatory cytokines (IL-6, IL-1β, and MCP-1) were ameliorated by the administration of ghrelin prior to reperfusion versus the concentrations observed in animals subjected to I/R alone. Significantly fewer monocytes in the tissue sections of I/R+ghrelin animals versus those subjected to I/R alone. Exogenous ghrelin administration prior to reperfusion of an ischemic heart resulted in a significant reduction in myocardial injury as measured by cTn-I. The reduced myocardial injury was accompanied by an attenuated tissue expression of several pro-inflammatory mediators, including VCAM-1, IL-6, IL-1β, and MCP-1.
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Lindman BR, Pibarot P, Arnold SV, Suri RM, McAndrew TC, Maniar HS, Zajarias A, Kodali S, Kirtane AJ, Thourani VH, Tuzcu EM, Svensson LG, Waksman R, Smith CR, Leon MB. Transcatheter versus surgical aortic valve replacement in patients with diabetes and severe aortic stenosis at high risk for surgery: an analysis of the PARTNER Trial (Placement of Aortic Transcatheter Valve). J Am Coll Cardiol 2013; 63:1090-9. [PMID: 24291272 DOI: 10.1016/j.jacc.2013.10.057] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/11/2013] [Accepted: 10/17/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS). BACKGROUND Diabetes is associated with increased morbidity and mortality after surgical AVR for AS. METHODS Among treated patients with severe symptomatic AS at high risk for surgery in the PARTNER (Placement of Aortic Transcatheter Valve) trial, we examined outcomes stratified according to diabetes status of patients randomly assigned to receive transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year. RESULTS Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p = 0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to 0.99]; p = 0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among nondiabetic patients, there was no significant difference in all-cause mortality at 1 year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p = 0.88), but the rate of renal failure requiring dialysis >30 days was lower in the transcatheter group (0% vs. 6.1%; p = 0.003). CONCLUSIONS Among patients with diabetes and severe symptomatic AS at high risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter AVR compared with surgical AVR. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
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Affiliation(s)
- Brian R Lindman
- Washington University School of Medicine, St. Louis, Missouri.
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | | | - Hersh S Maniar
- Washington University School of Medicine, St. Louis, Missouri
| | - Alan Zajarias
- Washington University School of Medicine, St. Louis, Missouri
| | - Susheel Kodali
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | | | | | | | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC
| | - Craig R Smith
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
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Toikkanen V, Rinne T, Huhtala H, Laurikka J, Porkkala H, Tarkka M, Mennander A. Cardiopulmonary bypass decreases pulmonary vascular resistance index after coronary artery bypass surgery. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 74:37-43. [DOI: 10.3109/00365513.2013.856032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Simsek E, Karapinar K, Bugra O, Tulga Ulus A, Sarigul A. Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery. Asian J Surg 2013; 37:93-9. [PMID: 24210839 DOI: 10.1016/j.asjsur.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 07/16/2013] [Accepted: 09/23/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. MATERIALS AND METHODS Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. RESULTS Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). CONCLUSION Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response.
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Affiliation(s)
- Erdal Simsek
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
| | - Kasim Karapinar
- Department of Cardiovascular Surgery, Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Onursal Bugra
- Department of Cardiovascular Surgery, İzzet Baysal University, Bolu, Turkey
| | - Ahmet Tulga Ulus
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ali Sarigul
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Konya, Turkey
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Hall R. Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:983-1033. [DOI: 10.1053/j.jvca.2012.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 12/21/2022]
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Bjorgvinsdottir L, Indridason OS, Heidarsdottir R, Skogstrand K, Arnar DO, Torfason B, Hougaard DM, Palsson R, Skuladottir GV. Inflammatory response following heart surgery and association with n-3 and n-6 long-chain polyunsaturated fatty acids in plasma and red blood cell membrane lipids. Prostaglandins Leukot Essent Fatty Acids 2013; 89:189-94. [PMID: 23999253 DOI: 10.1016/j.plefa.2013.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/12/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Open heart surgery is associated with a systemic inflammatory response. The n-3 long-chain polyunsaturated fatty acids (LC-PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the n-6 LC-PUFA arachidonic acid (AA) may contribute to modulation of the inflammatory response. OBJECTIVE We investigated whether the preoperative levels of EPA, DHA and AA in plasma phospholipids (PL) and red blood cell (RBC) membrane lipids in patients (n=168) undergoing open heart surgery were associated with changes in the plasma concentration of selected inflammatory mediators in the immediate postoperative period. RESULTS AND CONCLUSIONS The postoperative concentration of TNF-β was lower (P<0.05) and those of hs-CRP, IL-6, IL-8, IL-18 and IL-10 higher (P<0.05) than the respective preoperative concentrations. We observed that the preoperative levels of EPA and AA in plasma PL and RBC membrane lipids were associated with changes in the concentration of pro-inflammatory and anti-inflammatory mediators, suggesting a complex role in the postoperative inflammatory process.
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Affiliation(s)
- L Bjorgvinsdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, IS-101 Reykjavik, Iceland
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Wu Q, Purusram G, Wang H, Yuan R, Xie W, Gui P, Dong N, Yao S. The efficacy of parecoxib on systemic inflammatory response associated with cardiopulmonary bypass during cardiac surgery. Br J Clin Pharmacol 2013; 75:769-78. [PMID: 22835079 DOI: 10.1111/j.1365-2125.2012.04393.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 07/13/2012] [Indexed: 12/31/2022] Open
Abstract
AIMS Cardiopulmonary bypass (CPB) during cardiac surgery is well known to be associated with the development of a systemic inflammatory response. The efficacy of parecoxib in attenuating this systemic inflammatory response is still unknown. METHODS Patients undergoing elective mitral valve replacement with CPB were assessed, enrolled and randomly allocated to receive parecoxib (80 mg) or placebo. Blood samples were collected in EDTA vials for measuring serum cytokine concentrations, troponin T, creatinekinase myocardial-brain isoenzyme CK-MB concentrations and white cell counts. RESULTS Compared with the control group, IL-6 and IL-8-values in the parecoxib group increased to a lesser extent, peaking at 2 h after the end of CPB (IL-6 31.8 pg ml⁻¹ ± 4.7 vs. 77.0 pg ml⁻¹ ± 14.1, 95% CI -47.6, -42.8, P < 0.001; IL-8 53.6 pg ml⁻¹ ± 12.6 vs. 105.7 pg ml⁻¹ ± 10.8, 95% CI -54.8, -49.4, P < 0.001). Peak concentrations of anti-inflammatory cytokine IL-10 occurred immediately after termination of CPB and were higher in the parecoxib group (115.7 pg ml⁻¹ ± 10.5 vs. 88.4 pg ml⁻¹ ± 12.3, 95% CI 24.7, 29.9, P < 0.001). Furthermore, the increase in neutrophil counts caused by CPB during cardiac surgery was inhibited by parecoxib. The increases in serum troponin T and CK-MB concentrations were also significantly attenuated by parecoxib in the early post-operative days. Peak serum concentrations of CK-MB in both groups occurred at 24 h post-CPB (17.4 μg l⁻¹ ± 5.2 vs. 26.9 μg l⁻¹ ± 6.9, 95% CI -10.9, -8.1, P < 0.001). Peak troponin T concentrations occurred at 6 h post-bypass (2 μg l⁻¹ ± 0.62 vs. 3.5 μg l⁻¹ ± 0.78, 95% CI -1.7, -1.3, P < 0.001). CONCLUSION Intra-operative parecoxib attenuated the systemic inflammatory response associated with CPB during cardiac surgery and lowered the biochemical markers of myocardial injury.
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Affiliation(s)
- Qingping Wu
- Department of Anaesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Continuous Renal Replacement Therapy (CRRT) Attenuates Myocardial Inflammation and Mitochondrial Injury Induced by Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) in a Healthy Piglet Model. Inflammation 2013; 36:1186-93. [DOI: 10.1007/s10753-013-9654-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Therapeutic Potential of Tumour Necrosis Factor-alpha Antagonists in Patients with Chronic Heart Failure. Heart Lung Circ 2013; 22:323-7. [DOI: 10.1016/j.hlc.2012.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 11/27/2012] [Accepted: 12/02/2012] [Indexed: 12/23/2022]
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Cheng W, Xiao Y, Chen L, Liu H, Zhu Y. Application of lower sternal incision with on-pump, beating heart intracardiac procedures in congenital heart disease. Heart Surg Forum 2012; 15:E236-9. [PMID: 22917832 DOI: 10.1532/hsf98.20111189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to explore the application of lower sternal incision with on-pump, beating heart intracardiac procedures for the treatment of congenital heart disease. METHODS A total of 106 cases with congenital heart disease were performed with lower sternal incision under the beating heart condition. The sternum was sawed open to the third sternocostal joint through a small incision in the lower sternum. Cardiopulmonary bypass was developed without aortic cross-clamping. The simultaneous left atrium and ventricle suction and integrating sequential deairing procedure was established to improve the exposure of the surgical field and intraoperative de-airing. We also randomly selected 100 patients with similar disease and age as controls. These control patients underwent middle sternal incision surgery with arresting heart. RESULTS The results showed that all the patients were successfully completed with the surgery without death and serious complications, eg, air embolism, residual shunt, and complete atrioventricular block. The operative and cardiopulmonary bypass time in the experimental group was not significantly different from that in the control group. The length of the skin incision in the experimental group was shortened by 4.8 cm compared to that in the control group. The incidence of sternal deformity in patients under 3 years old in the experimental group was significantly lower than that in the control group. CONCLUSIONS Lower sternal incision with beating heart can reduce the surgical injury, simplify the operation procedure, and improve the therapeutic efficacy. It is a safe and effective approach for the treatment of congenital heart disease.
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Affiliation(s)
- Wei Cheng
- Cardiovascular Surgery Center, Xinqiao Hospital of the Third Military Medical University, Chongqing, China
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Williams JM, Young P, Pilcher J, Weatherall M, Miller JH, Beasley R, La Flamme AC. Remote ischaemic preconditioning does not alter perioperative cytokine production in high-risk cardiac surgery. HEART ASIA 2012; 4:97-101. [PMID: 27326040 DOI: 10.1136/heartasia-2012-010122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 01/25/2023]
Abstract
RATIONALE Remote ischaemic preconditioning (RIPC) is a novel cardioprotective strategy that uses brief intermittent limb ischaemia to protect the myocardium and other organs from perioperative ischaemic damage. The precise mechanism through which this protective effect occurs is unknown, but potentially could be related to changes in blood-borne mediators such as cytokines. OBJECTIVE To determine whether RIPC alters inflammatory cytokine expression in a double-blind, randomised, controlled trial of patients undergoing high-risk cardiac surgery. METHODS AND RESULTS Serum interleukin (IL)-6, IL-8, and IL-10 levels from 95 patients randomised to RIPC (n=47) or control treatment (n=48) were measured preoperatively, and 1, 2, 3, 6 and 12 h after cross-clamp removal. Systemic concentrations of all cytokines were increased from baseline following surgery, and, compared with simple procedures, complex surgeries were associated with significantly higher release of IL-6 (ratio of mean area under the curves 1.54 (95% CI 1.02 to 2.34), p=0.04) and IL-10 (1.97 (1.16 to 3.35), p=0.012). No significant difference in mean cytokine levels between the RIPC and control groups was detected at any time point, irrespective of the type of surgery undergone. CONCLUSIONS High levels of IL-6, IL-8 and IL-10 are produced during high-risk cardiac surgery, and RIPC does not alter these elevated perioperative cytokine concentrations. Identification of factors that influence the ability to induce RIPC-mediated cardioprotection should be the priority of future research. TRIAL REGISTRATION is in the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTRN12609000965202).
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Affiliation(s)
- Jenni M Williams
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Paul Young
- Capital and Coast District Health Board, Wellington, New Zealand; Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Janine Pilcher
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - John Holmes Miller
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Richard Beasley
- Capital and Coast District Health Board, Wellington, New Zealand; Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Anne Camille La Flamme
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
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Mo A, Wen Z, Lin H, Lu C, Liang S. Mitral valve replacements under on-pump beating heart and lung perfusion/ventilation using a minithoracotomy: an experience with 11 cases. Heart Surg Forum 2012; 15:E133-5. [PMID: 22698599 DOI: 10.1532/hsf98.20121013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The primary aims of minimally-invasive cardiac valve surgery are to lessen the impact of the incision, extracorporeal circulation, myocardial ischemia, and pulmonary ischemia, to obtain satisfactory therapeutic results, and to allow a quicker rehabilitation. In this study, the feasibility of minimally-invasive mitral valve replacements without ascending aorta and vena cava cross-clamping under beating heart was evaluated by surveying 11 patients. METHODS Preoperative risk factors, intraoperative techniques, and postoperative complications were surveyed and evaluated for one year (April 1, 2009 to March 30, 2010) in 11 patients who had undergone beating-heart mitral valve replacement surgery at The People's Hospital of Guangxi Zhuang Autonomous Region. Minithoracotomy and femoral arterial cannulation procedures were used in the surgeries for cardiopulmonary bypass (CPB) without ascending aorta and vena cava cross-clamping. RESULTS The operations were performed successfully in all 11 patients. The CPB time was 52.80 ± 11.36 minutes; the mean postoperative mechanical ventilation assistance time was 8.20 ± 2.84 hours; and the mean transfusion volume of red cells was 2.20 ± 1.04 units. There were no cerebral complications, no periprosthetic leakage, no occurrence of permanent high-degree atrioventricular blockage, and no mortality. CONCLUSION Mitral valve replacement on the beating heart using a minithoracotomy and femoral arterial cannulation for CPB without ascending aorta and vena cava crossclamping under pulmonary ventilation is feasible. A larger number of patients are required to further characterize the efficacy and safety of this procedure.
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Affiliation(s)
- Ansheng Mo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
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Transforming Growth Factor-α Enhances Stem Cell-Mediated Postischemic Myocardial Protection. Ann Thorac Surg 2011; 92:1719-25. [DOI: 10.1016/j.athoracsur.2011.06.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 11/21/2022]
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Machado LB, Negri EM, Bonafé WW, Santos LM, Sá Malbouisson LM, Carmona MJC. [Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft]. Rev Bras Anestesiol 2011; 61:275-85. [PMID: 21596187 DOI: 10.1016/s0034-7094(11)70033-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 12/07/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Systemic inflammatory response syndrome is commonly observed in coronary artery bypass grafts (CABG) with cardiopulmonary bypass (CB). The objective of this study was to evaluate the systemic and pulmonary levels of cytokines and their correlation with lung function in patients undergoing myocardial revascularization (MR) with CB. METHODS This study was approved by the Institutional Ethics Committee, and 13 patients undergoing MR with CB were evaluated. After anesthetic induction and at the end of CB, plasma and bronchoalveolar lavage levels of IL-1β, IL-6, IL-8, IL-10, and TNF-α were determined. The duration of CB and surgery, PaO(2)/FiO(2) ratio, alveolar-arterial oxygen gradient (A-a gradient), shunt, and lung compliance were evaluated. Results were submitted to analysis of variance for repeated measurements (*p < 0.05) and Spearman's correlation coefficient. RESULTS We observed increased levels of cytokines in plasma and bronchoalveolar lavage after CB and a direct relationship between the increase in IL-1β and decrease in lung compliance (p = 0.0439), as well as the inverse relationship between the increase in IL-10 and a decrease in compliance (p = 0.0325). The increase in IL-6 was directly related to the duration of CB (p = 0.012), while the increase in IL-8 was directly related to the duration of surgery (p < 0.0001). Levels of interleukin-1β, IL-8, and TNF-α in bronchoalveolar lavage were higher than in plasma. CONCLUSIONS There is an increase in cytokine levels in plasma and bronchoalveolar lavage after CB, as well as a correlation between increased cytokine levels and CB duration and surgery and changes in lung compliance.
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Pattern of activin A and follistatin release in a sheep model of cardiopulmonary bypass. Cytokine 2011; 54:154-60. [DOI: 10.1016/j.cyto.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 12/11/2010] [Accepted: 01/02/2011] [Indexed: 11/22/2022]
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Mo A, Lin H. On-pump Beating Heart Surgery. Heart Lung Circ 2011; 20:295-304. [DOI: 10.1016/j.hlc.2011.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 01/16/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Preceding unstable angina affects inflammatory response and hemodynamics after coronary artery bypass surgery. Int J Angiol 2011. [DOI: 10.1007/bf01616407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bulcao CF, D'Souza KM, Malhotra R, Staron M, Duffy JY, Pandalai PK, Jeevanandam V, Akhter SA. Activation of JAK-STAT and nitric oxide signaling as a mechanism for donor heart dysfunction. J Heart Lung Transplant 2010; 29:346-51. [PMID: 20022263 DOI: 10.1016/j.healun.2009.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Donor heart dysfunction (DHD) precluding procurement for transplantation occurs in up to 25% of brain-dead (BD) donors. The molecular mechanisms of DHD remain unclear. We investigated the potential role of myocardial interleukin (IL)-6 signaling through the JAK2-STAT3 pathway, which can lead to the generation of nitric oxide (NO) and decreased cardiac myocyte contractility. METHODS Hearts were procured using standard technique with University of Wisconsin (UW) solution from 14 donors with a left ventricular (LV) ejection fraction of <35% (DHD). Ten hearts with normal function (NF) after BD served as controls. LV IL-6 was quantitated by enzyme-linked immunoassay (ELISA) and JAK2-STAT3 signaling was assessed by expression of phosphorylated STAT3. Inducible NO synthase (iNOS) and caspase-3 were measured by activity assays. RESULTS Myocardial IL-6 expression was 8-fold greater in the DHD group vs NF controls. Phosphorylated STAT3 expression was 5-fold higher in DHD than in NF, indicating increased JAK2-STAT3 signaling. LV activity of iNOS was 2.5-fold greater in DHD than in NF. LV expression of the pro-apoptotic gene Bnip3 and caspase-3 activity were 3-fold greater in the DHD group than in the NF group. CONCLUSIONS Myocardial IL-6 expression is significantly higher in the setting of DHD compared with hearts procured with normal function. This may lead to increased JAK2-STAT3 signaling and upregulation of iNOS, which has been shown to decrease cardiac myocyte contractility. Increased NO production may also lead to increased apoptosis through upregulation of Bnip3 gene expression. Increased iNOS signaling may be an important mechanism of DHD and represents a novel therapeutic target to improve cardiac function after BD.
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Affiliation(s)
- Christian F Bulcao
- Department of Surgery, Section of Cardiothoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Gazit AZ, Huddleston CB, Checchia PA, Fehr J, Pezzella AT. Care of the Pediatric Cardiac Surgery Patient—Part 1. Curr Probl Surg 2010; 47:185-250. [DOI: 10.1067/j.cpsurg.2009.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Feng W, Song Y, Chen C, Lu ZZ, Zhang Y. Stimulation of adenosine A(2B) receptors induces interleukin-6 secretion in cardiac fibroblasts via the PKC-delta-P38 signalling pathway. Br J Pharmacol 2009; 159:1598-607. [PMID: 20050850 DOI: 10.1111/j.1476-5381.2009.00558.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Inflammatory response and cytokine activation are markedly stimulated after myocardial infarction, and contribute to cardiac remodelling. Interleukin-6 (IL-6), a pro-inflammatory cytokine, has pleiotropic effects on cardiac remodelling. Adenosine, released by all cell types, binds to a class of G protein-coupled receptors to induce various cardiovascular effects. The aim of this work was to investigate whether activation of adenosine receptors, particularly A(2B) adenosine receptors, could stimulate IL-6 secretion in cardiac fibroblasts (CFs). EXPERIMENTAL APPROACH elisa was used to assess IL-6 concentration in supernatant, and immunostaining was used to analyse IL-6 protein level in CFs. The levels of phosphorylated and total p38, extracellular signal-regulated kinase, c-Jun N-terminal kinase and protein kinase C-delta (PKC-delta) were determined by Western blot analysis. KEY RESULTS Adenosine-5'-N-ethyluronamide (NECA), a stable adenosine analogue, dose- and time-dependently stimulated IL-6 secretion in CFs. The effect of NECA was dose-dependently inhibited by an A(2B) antagonist, and silencing of the A(2B) receptor also inhibited IL-6 secretion. By using PKC isoform-selective inhibitors and translocation peptide inhibitors, the PKC-delta isoform was found to be involved in the up-regulation of IL-6 production. Inhibition of p38 by SB203580, and adenoviral transfer of dominant-negative p38 inhibited NECA-induced IL-6 production. Furthermore, PKC-delta functioned as an upstream regulator of p38 MAPK in this process. CONCLUSIONS AND IMPLICATIONS We demonstrated a novel relationship between adenosine and IL-6 secretion, in that IL-6 secretion induced by NECA was mediated by adenosine A(2B) receptor activation in CFs and was dependent on a PKCdelta-P38 pathway.
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Affiliation(s)
- Wei Feng
- Institute of Vascular Medicine, Peking University Third Hospital, Ministry of Education, Beijing, China
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Poston RS, Kwon MH, Gu J. Role of procurement-related injury in early saphenous vein graft failure after coronary artery bypass surgery. Future Cardiol 2009; 2:503-12. [PMID: 19804185 DOI: 10.2217/14796678.2.4.503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Saphenous vein graft thrombosis after coronary artery bypass graft surgery is a poorly understood problem that lessens the benefits of this procedure. Recent studies highlight the importance of injury sustained at the time of saphenous vein graft procurement in the pathogenesis of acute graft thrombosis. In particular, damage to the graft endothelium that occurs secondary to ex vivo pressure distention, a common practice during vein harvest, leads to a loss of antithrombotic factors and increased activity of subendothelial prothrombotic factors. The prothrombotic potential of damaged grafts is further exacerbated by an ischemic storage interval and subsequent exposure to arterial flow conditions after grafting. A clearer understanding of the mechanisms by which endothelial disruption leads to acute saphenous vein graft thrombosis may result in interventions for improving our procurement techniques, interrupting the downstream effects of the damaged saphenous vein graft and/or discriminating damage that is beyond an acceptable threshold of thrombotic risk.
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Affiliation(s)
- Robert S Poston
- University of Maryland, School of Medicine, Department of Surgery, Division of Cardiac Surgery, 22 South Greene St, N4W94 Baltimore, MD 21201, USA.
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