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Mukharyamov M, Schneider U, Kirov H, Caldonazo T, Doenst T. Myocardial protection in cardiac surgery-hindsight from the 2020s. Eur J Cardiothorac Surg 2023; 64:ezad424. [PMID: 38113432 DOI: 10.1093/ejcts/ezad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023] Open
Abstract
Myocardial protection and specifically cardioplegia have been extensively investigated in the beginnings of cardiac surgery. After cardiopulmonary bypass had become routine, more and more cardiac operations were possible, requiring reliable and reproducible protection for times of blood flow interruptions to the most energy-demanding organ of the body. The concepts of hypothermia and cardioplegia evolved as tools to extend cardiac ischaemia tolerance to a degree considered safe for the required operation. A plethora of different solutions and delivery techniques were developed achieving remarkable outcomes with cross-clamp times of up to 120 min and more. With the beginning of the new millennium, interest in myocardial protection research declined and, as a consequence, conventional cardiac surgery is currently performed using myocardial protection strategies that have not changed in decades. However, the context, in which cardiac surgery is currently performed, has changed during this time. Patients are now older and suffer from more comorbidities and, thus, other organs move more and more into the centre of risk assessment. Yet, systemic effects of cardioplegic solutions have never been in the focus of attention. They say hindsight is always 20-20. We therefore review the biochemical principles of ischaemia, reperfusion and cardioplegic extension of ischaemia tolerance and address the concepts of myocardial protection with 'hindsight from the 2020s'. In light of rising patient risk profiles, minimizing surgical trauma and improving perioperative morbidity management becomes key today. For cardioplegia, this means accounting not only for cardiac, but also for systemic effects of cardioplegic solutions.
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Affiliation(s)
- Murat Mukharyamov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
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Klaeske K, Dix M, Adams V, Jawad K, Eifert S, Etz C, Saeed D, Borger MA, Dieterlen MT. Differential Regulation of Myocardial E3 Ligases and Deubiquitinases in Ischemic Heart Failure. Life (Basel) 2021; 11:life11121430. [PMID: 34947961 PMCID: PMC8708923 DOI: 10.3390/life11121430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
The pathological changes of ubiquitination and deubiquitination following myocardial infarction (MI) and chronic heart failure (CHF) have been sparsely examined. We investigated the expression of muscle-specific E3 ubiquitin ligases and deubiquitinases in MI and CHF. Therefore, mice were assigned to coronary artery ligation for 3 days or 10 weeks as well as for sham operation (each n = 10). Expression of E3 ligases (MAFBX, MURF1, CHIP, ITCH, MDM2) and deubiquitinases (A20, CYLD, UCH-L1, USP14, USP19) was determined. After MI and in CHF, the mRNA expression of MURF1, CHIP and MDM2 (all p < 0.05) was decreased. Protein expression analyses revealed that ITCH expression decreased in CHF (p = 0.01), whereas MDM2 expression increased in MI (p = 0.02) and decreased in CHF (p = 0.02). Except for USP19 mRNA expression that decreased at 3 days and 10 weeks (both p < 0.01), the expression of other deubiquitinases remained unaffected after MI and CHF. The expression of myocardial E3 ligases is differentially regulated following MI, raising the question of whether an upstream regulation exists that is activated by MI for tissue protection or whether the downregulation of E3 ligases enables myocardial hypertrophy following MI.
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Affiliation(s)
- Kristin Klaeske
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
- Correspondence: ; Tel.: +49-341865251079; Fax: +49-3418651452
| | - Maria Dix
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Volker Adams
- Laboratory of Molecular and Experimental Cardiology, Heart Center Dresden, TU Dresden, Fetscherstraße 76, 01307 Dresden, Germany;
- Dresden Cardiovascular Research Institute and Core Laboratories GmbH, Bautzner Straße 122c, 01099 Dresden, Germany
| | - Khalil Jawad
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Sandra Eifert
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Christian Etz
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Diyar Saeed
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Michael A. Borger
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Maja-Theresa Dieterlen
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
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Relevance and Recommendations for the Application of Cardioplegic Solutions in Cardiopulmonary Bypass Surgery in Pigs. Biomedicines 2021; 9:biomedicines9091279. [PMID: 34572465 PMCID: PMC8464907 DOI: 10.3390/biomedicines9091279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
Cardioplegic solutions play a major role in cardiac surgery due to the fact that they create a silent operating field and protect the myocardium against ischemia and reperfusion injury. For studies on cardioplegic solutions, it is important to compare their effects and to have a valid platform for preclinical testing of new cardioplegic solutions and their additives. Due to the strong anatomical and physiological cardiovascular similarities between pigs and humans, porcine models are suitable for investigating the effects of cardioplegic solutions. This review provides an overview of the results of the application of cardioplegic solutions in adult or pediatric pig models over the past 25 years. The advantages, disadvantages, limitations, and refinement strategies of these models are discussed.
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