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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2002 August;43(4):441-7

language: English

Clinical evaluation of oxidative stress and myocardial reperfusion injury in pediatric cardiac surgery

Calza G., Lerzo F., Perfumo F. 1, Borini I., Panizzon G., Moretti R. 2, Grasso P. 2, Virgone A., Zannini L.

Department of Cardiovascular Surgery 1 Nephrology and 2 Anesthesiology Giannina Gaslini Institute, Children’s Hospital Genoa, Italy


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Background. To eval­u­ate oxi­da­tive ­stress ­and myo­car­dial dam­age ­after aor­tic cross­clamp­ing ­release (ACCR) dur­ing cardio pulmonary bypass (­CPB) in chil­dren ­two param­e­ters ­were inves­ti­gat­ed: ­total glutathione (­GSH) ­and ­its oxi­dor­e­duc­tive reac­tions (GSH/­GSSG) as expres­sion of oxi­da­tive ­stress, ­and plas­mat­ic turn­over of myo­car­dial taurine (­TAU) as expres­sion of ­cell dam­age.
Methods. The ­study ­was divid­ed in ­two peri­ods: 1) first period: anal­y­sis of oxi­da­tive ­stress ­and myo­car­dial dam­age in 18 chil­dren. 2) Second peri­od: eval­u­a­tion of myo­car­dial ­cell pro­tec­tion by con­trolled anterograde low oxygen warm reperfusion (­ALOWR) ­before declamp­ing. Twenty-one chil­dren ­were divid­ed in ­two ­groups: ­not receiv­ing (Group 1, 9 ­patients) ­and receiv­ing (Group 2, 12 ­patients) ­ALOWR.
Results. In ­the ­first peri­od ­GSH val­ues ­increased sig­nif­i­cant­ly ­after ­onset of mechan­i­cal ven­ti­la­tion (MV) in ­vein, ­after ­CPB ­start in ­artery ­and ­after ACCR in cor­o­nary syn­us. Moreover ­TAU turn­over in aor­tic ­and cor­o­nary ­sinus ­blood ­increased sig­nif­i­cant­ly ­after ­ACCR. In ­the sec­ond peri­od, Group 2 ­showed a low­er oxi­da­tive ­stress ­after ­ACCR, ­while no dif­fer­enc­es ­were ­observed in ­TAU turn­over.
Conclusions. 1) Assessment of ­TAU ­and ­GSH lev­els ­can be con­sid­ered a ­good meth­od to clin­i­cal­ly eval­u­ate myo­car­dial inju­ry dur­ing car­diac sur­gery. 2) MV ­and ­CPB ­can ­induce oxi­da­tive ­stress ­before aor­tic clamp­ing ­and ­can ­decrease ­the phys­io­log­ic scav­en­gers. Therefore, to pre­vent ­that deple­tion, ­the strat­e­gy of ­these tech­niques ­must be adapt­ed to ­the ­patient ­and to ­his car­diac dis­ease. 3) Intramyocardial ­TAU turn­over is ­not sig­nif­i­cant­ly mod­i­fied by ­the reper­fu­sion tech­nique. 4) ­ALOWR ­can ­reduce myo­car­dial oxi­da­tive ­stress ­and ­can ­improve ­heart recov­ery ­after ­the car­di­o­pleg­ic ­arrest.

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