A review of anti-inflammatory strategies in cardiac surgery

Asimakopoulos, George; Gourlay, Terence

doi:10.1191/0267659103pf623oa

Cited by 29 publications

(14 citation statements)

References 38 publications

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“…Several anti-inﬂammatory procedures and pharmacological agents have been used in cardiac surgery to attenuate myocardial inﬂammatory injury, including the use of leukocyte filtration, corticosteroids, aprotinin, heparin, and nitrogen monoxidum donor compounds [32]. Despite the relatively small number of studies investigating the effects of reducing the inﬂammatory response on myocardial injury, the vast majority of these studies have shown that therapies targeting myocardial inﬂammatory response are beneficial in salvaging myocardium.…”

Section: Discussionmentioning

confidence: 99%

Cardioprotective Effect of Ghrelin in Cardiopulmonary Bypass Involves a Reduction in Inflammatory Response

et al. 2013

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BackgroundGhrelin has been reported to protect the cardiovascular system; however, the cardioprotective effect of ghrelin against cardiopulmonary bypass (CPB) induced myocardial injury are unclear. In this study, the protective effect of ghrelin on CPB induced myocardial injury and the underlying mechanisms were investigated.Methods and ResultsAdult male rats were subjected to CPB and randomly to receive vehicle (n = 8), ghrelin (n = 8), ghrelin plus [D-Lys3]-GHRP-6, a GHSR-1a inhibitor (n = 8), or ghrelin plus wortmannin, a phosphoinositide 3′-kinase (PI3K) inhibitor (n = 8). In vitro study was performed on cultured cardiomyocytes subjected to simulated cardiopulmonary bypass (SCPB). Ghrelin attenuated the inﬂammatory response, as evidenced by reduced induction of TNF-α, IL-6 and myocardial myeloperoxidase activity and concurrent reduction in apoptosis, oxidative stress, and levels of myocardial injury markers following CPB. Moreover, ghrelin significantly increased cardiac function after CPB. In cultured cardiomyocytes subjected to simulated CPB, ghrelin increased cell viability and decreased the percentage of apoptotic myocytes. Inhibition of ghrelin downstream signaling blocked the cardioprotective effects both in vivo and vitro.ConclusionsGhrelin could provide an effective approach to the attenuation of CPB induced myocardial injury. The cardioprotective effects elicited by ghrelin may contribute to the inhibition of inflammatory response through the Akt-activated pathway.

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Section: Discussionmentioning

confidence: 99%

Cardioprotective Effect of Ghrelin in Cardiopulmonary Bypass Involves a Reduction in Inflammatory Response

et al. 2013

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“…Most Patients undergoing cardiac surgical procedures with CPB have SIRS [15-17] The antioxidant and anti-inflammatory effects of PTX have been showed in many studies [18,19]. PTX has also been reported to exhibit anticoagulation properties by improving red blood cell deformability, decreasing red blood cell aggregation, and inhibiting neutrophil adhesion [20].…”

Section: Discussionmentioning

confidence: 99%

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Barkhordari

Karimi

Shafiee

et al. 2011

J Cardiothorac Surg

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BackgroundBased on Acute Kidney Injury Network (AKIN) criteria, we considered acute kidney injury (AKI) as an absolute increase in the serum creatinine (sCr) level of more than or equal to 0.3 mg/dl or 50%. The introduction of Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, can suppress the production of some factors of inflammatory response and presumably prevent AKI. We examined the PTX on the development of AKI in cardiac surgery patients by measuring the levels of UNGAL.Materials and methodsWe performed a double blind randomized clinical trial, enrolling 28 consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery. Patients were divided into two groups, one to receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h continuous intravenous infusion until 3 hours after cessation of CPB and the other group received placebo. UNGAL was measured before, 3 and 24 hours after surgery. In addition serum creatinine was measured before and 24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24 hours postoperatively.ResultsBoth groups did not differ in demographic and baseline characteristics. 12 patients developed AKI 48 hours after surgery; 5 of them were in the intervention group and 7 in the control group (p= 0.445). There was an increase of UNGAL in both groups postoperatively, although not significant. Mean sCr was significantly increased in the control group at 24 and 48 hours after surgery (24-h mean: 0.79 ± 0.18 mg/dl vs. 1.03 ± 0.43 mg/dl, P value = 0.02; 48-h mean: 1.17 ± 0.24 mg/dl vs. 0.98 ± 0.20 mg/dl, P value = 0.03, respectively). PTX had a positive effect in preventing AKI reflecting in changes in sCr, and the increase of UNGAL was consistent with the emergence of AKI (Pearson's correlation = 0.30).ConclusionOur study demonstrates a weak correlation between UNGAL and sCr after cardiac surgery. The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance. PTX could reduce the occurrence of AKI as determined by attenuation of sCr rise without causing hemodynamic instability or increased bleeding. Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.Trial RegistrationISRCTN: IRCT138807302622N1

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“…Several anti‐inflammatory techniques and pharmacological agents (largely aimed at coping with CPB) have been used in recent years in cardiac surgery. These include leukocyte filtration, corticosteroids, aprotinin, heparin and NO donor compounds ( Harig et al , 2001 ; Paparella et al , 2002 ; Asimakopoulos and Gourlay, 2003 ; Goudeau et al , 2007 ). Despite the relatively small number of studies investigating the effects of reducing the inflammatory response on myocardial reperfusion injury, majority of these studies have shown evidence of myocardial protection.…”

Section: Cardioprotective Strategies During Open‐heart Surgerymentioning

confidence: 99%

Inflammatory response and cardioprotection during open‐heart surgery: the importance of anaesthetics

Suleiman

Zacharowski

Angelini

2008

British J Pharmacology

137

108

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Open-heart surgery triggers an inflammatory response that is largely the result of surgical trauma, cardiopulmonary bypass, and organ reperfusion injury (e.g. heart). The heart sustains injury triggered by ischaemia and reperfusion and also as a result of the effects of systemic inflammatory mediators. In addition, the heart itself is a source of inflammatory mediators and reactive oxygen species that are likely to contribute to the impairment of cardiac pump function. Formulating strategies to protect the heart during open heart surgery by attenuating reperfusion injury and systemic inflammatory response is essential to reduce morbidity. Although many anaesthetic drugs have cardioprotective actions, the diversity of the proposed mechanisms for protection (e.g. attenuating Ca 2 þ overload, anti-inflammatory and antioxidant effects, pre-and post-conditioning-like protection) may have contributed to the slow adoption of anaesthetics as cardioprotective agents during open heart surgery. Clinical trials have suggested at least some cardioprotective effects of volatile anaesthetics. Whether these benefits are relevant in terms of morbidity and mortality is unclear and needs further investigation. This review describes the main mediators of myocardial injury during open heart surgery, explores available evidence of anaesthetics induced cardioprotection and addresses the efforts made to translate bench work into clinical practice.

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A review of anti-inflammatory strategies in cardiac surgery

Cited by 29 publications

References 38 publications

Cardioprotective Effect of Ghrelin in Cardiopulmonary Bypass Involves a Reduction in Inflammatory Response

Cardioprotective Effect of Ghrelin in Cardiopulmonary Bypass Involves a Reduction in Inflammatory Response

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Inflammatory response and cardioprotection during open‐heart surgery: the importance of anaesthetics

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