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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 2017 December;58(6):909-15

DOI: 10.23736/S0021-9509.17.09736-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Effect of remote ischemic preconditioning on the melatonin and antioxidative status: a pilot study in patients undergoing cardiac surgery

Rafael STRUCK 1, Maria WITTMANN 1, Thomas RECHT 1, Georg BAUMGARTEN 1, Patrick MEYBOHM 2, Andreas MÜLLER 3, Soyhan BAGCI 3

1 Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany; 2 Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany; 3 Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany


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BACKGROUND: Remote ischemic preconditioning (RIPC), a phenomenon in which a transient ischemia applied to a nonvital tissue protects another organ or tissue from subsequent lethal ischemic injury, is reported to protect the myocardium to withstand a subsequent prolonged ischemic event in patients undergoing cardiac surgery with cardiopulmonary bypass. It remains unclear whether oxidative stress and endogenous antioxidant enzymes play a role in the mechanistic pathways of RIPC. The aim of the present study was to evaluate the effects of RIPC on oxidative stress and extracellular concentrations of melatonin, extracellular superoxide dismutase (eSOD) and extracellular glutathione peroxidase (eGPx) in patients undergoing cardiac surgery with cardiopulmonary bypass.
METHODS: Thirty-two patients were randomly assigned to receive either RIPC (N.=15) or sham-RIPC (N.=17). Blood samples were collected immediately before and after RIPC and at the end of surgery. Melatonin levels were determined by radioimmunoassay. Plasma concentrations of eSOD, eGPx and 8-hydroxydeoxyguanosine (8-OhdG) as a marker of DNA oxidative stress were measured via ELISA.
RESULTS: We found that RIPC compared to Sham-RIPC independently predicted higher melatonin concentrations at the end of surgery. However, it had no effect on eSOD, eGPx, and DNA oxidative stress. eSOD levels significantly increased during CPB time, while systemic eGPx levels decreased. High baseline melatonin concentration independently predicted lower 8-OHdG levels at the end of surgery.
CONCLUSIONS: Our results suggest that extracellular antioxidative enzymes such as eSOD and eGPx as well as oxidative stress levels in the perioperative period do not play a predominant role in the mechanistic pathways of RIPC. RIPC modulates systemic melatonin concentrations but does not affect eSOD, eGPx and oxidative stress levels.


KEY WORDS: Ischemic preconditioning - Melatonin - Antioxidants - Myocardial ischemia - Reperfusion injury - Oxidative stress

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Publication History

Issue published online: September 14, 2017
Article first published online: January 25, 2017
Manuscript accepted: January 19, 2017
Manuscript revised: January 4, 2017
Manuscript received: October 7, 2016

Cite this article as

Struck R, Wittmann M, Recht T, Baumgarten G, Meybohm P, Müller A, et al. Effect of remote ischemic preconditioning on the melatonin and antioxidative status: a pilot study in patients undergoing cardiac surgery. J Cardiovasc Surg 2017;58:909-15. DOI: 10.23736/S0021-9509.17.09736-1

Corresponding author e-mail

soyhan.bagci@ukb.uni-bonn.de