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Sabe SA, Harris DD, Broadwin M, Sellke FW. Cardioprotection in cardiovascular surgery. Basic Res Cardiol 2024:10.1007/s00395-024-01062-0. [PMID: 38856733 DOI: 10.1007/s00395-024-01062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
Since the invention of cardiopulmonary bypass, cardioprotective strategies have been investigated to mitigate ischemic injury to the heart during aortic cross-clamping and reperfusion injury with cross-clamp release. With advances in cardiac surgical and percutaneous techniques and post-operative management strategies including mechanical circulatory support, cardiac surgeons are able to operate on more complex patients. Therefore, there is a growing need for improved cardioprotective strategies to optimize outcomes in these patients. This review provides an overview of the basic principles of cardioprotection in the setting of cardiac surgery, including mechanisms of cardiac injury in the context of cardiopulmonary bypass, followed by a discussion of the specific approaches to optimizing cardioprotection in cardiac surgery, including refinements in cardiopulmonary bypass and cardioplegia, ischemic conditioning, use of specific anesthetic and pharmaceutical agents, and novel mechanical circulatory support technologies. Finally, translational strategies that investigate cardioprotection in the setting of cardiac surgery will be reviewed, with a focus on promising research in the areas of cell-based and gene therapy. Advances in this area will help cardiologists and cardiac surgeons mitigate myocardial ischemic injury, improve functional post-operative recovery, and optimize clinical outcomes in patients undergoing cardiac surgery.
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Affiliation(s)
- Sharif A Sabe
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA
| | - Dwight D Harris
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA
| | - Mark Broadwin
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA.
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Li A, Chen S, Wu J, Li J, Wang J. Ischemic Postconditioning Attenuates Myocardial Ischemia-Reperfusion-Induced Acute Lung Injury by Regulating Endoplasmic Reticulum Stress-Mediated Apoptosis. Braz J Cardiovasc Surg 2023; 38:79-87. [PMID: 35657304 PMCID: PMC10010732 DOI: 10.21470/1678-9741-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the effect of ischemic postconditioning on myocardial ischemia-reperfusion-induced acute lung injury (ALI). METHODS Forty adult male C57BL/6 mice were randomly divided into sham operation group (SO group), myocardial ischemia-reperfusion group (IR group), ischemic preconditioning group (IPRE group) and ischemic postconditioning group (IPOST group) (10 mice in each group). Anterior descending coronary artery was blocked for 60 min and then reperfused for 15 min to induce myocardial IR. For the IPRE group, 3 consecutive cycles of 5 min of occlusion and 5 minutes of reperfusion of the coronary arteries were performed before ischemia. For the IPOST group, 3 consecutive cycles of 5 min reperfusion and 5 minutes of occlusion of the coronary arteries were performed before reperfusion. Pathological changes of lung tissue, lung wet-to-dry (W/D) weight ratio, inflammatory factors, oxidative stress indicators, apoptosis of lung cells and endoplasmic reticulum stress (ERS) protein were used to evaluate lung injury. RESULTS After myocardial IR, lung injury worsened significantly, manifested by alveolar congestion, hemorrhage, structural destruction of alveolar septal thickening, and interstitial neutrophil infiltration. In addition, lung W/D ratio was increased, plasma inflammatory factors, including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-17A, were increased, malondialdehyde (MDA) activity of lung tissue was increased, and superoxide dismutase (SOD) activity was decreased after myocardial IR. It was accompanied by the increased protein expression levels of ERS-related protein glucose regulatory protein 78 (GRP78), CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP), and caspase-12, and the increased apoptotic indices of lung tissues. CONCLUSION IPOST can effectively improve myocardial IR-induced ALI by inhibiting ERS-induced apoptosis of alveolar epithelial cells.
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Affiliation(s)
- Aimei Li
- Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Siyu Chen
- Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Jianjiang Wu
- Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Jiaxin Li
- Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Jiang Wang
- Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
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Holt A, Blanche P, Jensen AKG, Nouhravesh N, Rajan D, Jensen MH, El-Sheikh M, Schjerning AM, Schou M, Gislason G, Torp-Pedersen C, McGettigan P, Lamberts M. Adverse Events Associated With Coprescription of Phosphodiesterase Type 5 Inhibitors and Oral Organic Nitrates in Male Patients With Ischemic Heart Disease : A Case-Crossover Study. Ann Intern Med 2022; 175:774-782. [PMID: 35436155 DOI: 10.7326/m21-3445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concomitant use of oral organic nitrates (nitrates) and phosphodiesterase type 5 (PDE5) inhibitors is contraindicated. OBJECTIVE To measure temporal trends in the coprescription of nitrates and PDE5 inhibitors and to measure the association between cardiovascular outcomes and the coprescription of nitrates with PDE5 inhibitors. DESIGN Case-crossover design. SETTING Nationwide study of Danish patients from 2000 to 2018. PATIENTS Male patients with International Classification of Diseases, 10th Revision (ICD-10) codes for ischemic heart disease (IHD), including those who had a continuing prescription for nitrates and a new, filled prescription for PDE5 inhibitors. MEASUREMENTS Two composite outcomes were measured: 1) cardiac arrest, shock, myocardial infarction, ischemic stroke, or acute coronary arteriography and 2) syncope, angina pectoris, or drug-related adverse event. RESULTS From 2000 to 2018, 249 541 male patients with IHD were identified. Of these, 42 073 patients had continuing prescriptions for nitrates. During this period, the prescription rate for PDE5 inhibitors in patients with IHD who were taking nitrates increased from an average of 0.9 prescriptions (95% CI, 0.5 to 1.2 prescriptions) per 100 persons per year in 2000 to 19.5 prescriptions (CI, 18.0 to 21.1 prescriptions) in 2018. No statistically significant association was found between the coprescription of nitrates with PDE5 inhibitors and the risk for either composite outcome (odds ratio [OR], 0.58 [CI, 0.28 to 1.13] for the first outcome and OR, 0.73 [CI, 0.40 to 1.32] for the second outcome). LIMITATION An assumption was made that concurrently filled prescriptions for nitrates and PDE5 inhibitors equaled concomitant use. CONCLUSION From 2000 to 2018, the use of PDE5 inhibitors increased 20-fold among Danish patients with IHD who were taking nitrates. A statistically significant association between concomitant use of these medications and cardiovascular adverse events could not be identified. PRIMARY FUNDING SOURCE Ib Mogens Kristiansens Almene Fond and Helsefonden.
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Affiliation(s)
- Anders Holt
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Paul Blanche
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark (P.B., A.K.G.J.)
| | | | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Deepthi Rajan
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Mads Hashiba Jensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Mohammed El-Sheikh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Anne-Marie Schjerning
- Department of Cardiology, Zealand University Hospital, Roskilde, and The Danish Heart Foundation, Copenhagen, Denmark (A.S.)
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, and The Danish Heart Foundation, Copenhagen, Denmark (G.G.)
| | - Christian Torp-Pedersen
- Department of Clinical Research, North Zealand Hospital, Hillerød, and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (C.T.)
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (P.M.)
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
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Mitić B, Jovanović A, Nikolić VN, Stokanović D, Andrejić OM, Vučić RM, Pavlović M, Ignjatović A, Momčilović S. Trend of Galectin-3 Levels in Patients with Non-ST-Elevation and ST-Elevation Myocardial Infarction. Medicina (B Aires) 2022; 58:medicina58020286. [PMID: 35208606 PMCID: PMC8874376 DOI: 10.3390/medicina58020286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Objectives: Given the fact that galectin-3 has a predictive significance on the development of myocardial dysfunction after acute myocardial infarction, the aim of our study was to examine potential factors that could be important for the dynamics of the concentration of this biomarker in the early postinfarction period. Materials and Methods: This study included 89 patients with a diagnosis of stable angina pectoris (SAP) or the first non-ST elevation (NSTEMI) or ST-elevation (STEMI) myocardial infarction, who underwent percutaneous coronary intervention (PCI). The study group included 23 patients with the first NSTEMI and 42 patients with STEMI, while the control group consisted of 24 patients with SAP hospitalized for elective PCI without a previous MI. All patients had preserved left ventricular ejection fraction. Galectin-3 levels were determined on days 1, 5, and 30 after PCI. The significance of various independent variables as predictors of galectin-3 concentration was analyzed after a series of univariate linear regression modeling in a multivariate linear regression model. Results: The average patients’ age was 63.99 ± 9.13 years. Statistically significantly higher values of C-reactive protein were established in STEMI compared to SAP (p < 0.01) or NSTEMI (p < 0.001), whereas WBC count was significantly lower in SAP than in STEMI (p < 0.001) and NSTEMI (p < 0.01) group. Although there were no statistically significant differences in measured galectin-3 concentrations between the examined groups on days 1, 5, and 30 after PCI, HTA, triglyceride level, LA size, treatment with trimetazidine and long-acting nitrates, as well as percentage of LM stenosis and E/A ratio were identified as independent predictors of galectin-3 concentration. Conclusions: In the post-MI period, very early values of galectin-3 correlate mostly with atherosclerosis factors, while on day 30 this biomarker correlates with diastolic dysfunction and “announces” left ventricular remodeling.
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Affiliation(s)
- Branka Mitić
- Department of Internal Medicine-Nephrology, Faculty of Medicine, University of Nis, Blvd Zorana Djindjića 81, 18000 Nis, Serbia; (B.M.); (A.J.)
| | - Andriana Jovanović
- Department of Internal Medicine-Nephrology, Faculty of Medicine, University of Nis, Blvd Zorana Djindjića 81, 18000 Nis, Serbia; (B.M.); (A.J.)
| | - Valentina N. Nikolić
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Nis, Blvd Zorana Djindjića 81, 18000 Nis, Serbia; (V.N.N.); (D.S.)
| | - Dragana Stokanović
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Nis, Blvd Zorana Djindjića 81, 18000 Nis, Serbia; (V.N.N.); (D.S.)
| | - Olivera M. Andrejić
- Clinic for Pulmonary Diseases, University Clinical Center Kragujevac, Zmaj Jovina Street 30, 34000 Kragujevac, Serbia;
| | - Rada M. Vučić
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica Street 69, 34000 Kragujevac, Serbia;
| | - Milan Pavlović
- Department of Internal Medicine-Cardiology, Faculty of Medicine, University of Nis, Blvd Zorana Djindjića 81, 18000 Nis, Serbia;
| | - Aleksandra Ignjatović
- Department of Medical Statistics, Faculty of Medicine, University of Nis, Blvd Zorana Djindjica 81, 18000 Nis, Serbia;
| | - Stefan Momčilović
- Plastic and Reconstructive Surgery Clinic, University Clinical Center Nis, Blvd Zorana Djindjica 48, 18000 Nis, Serbia
- Correspondence: ; Tel.: +381-605-263-654
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