Estudo comparativo experimental da proteção miocárdica com soluções cristalóides para transplante cardíaco

Abstract

Estudo comparativo experimental da proteção miocárdica com soluções cristalóides para transplante cardíacoComparative experimental study of myocardial protection with crystalloid solutions for heart transplantation Abstract Background: There is a growing need to improve myocardial protection, which will lead to better performance of cardiac operations and reduce morbidity and mortality. Therefore, the objective of this study was to compare the efficacy of myocardial protection solution using both intracellular and extracellular crystalloid type regarding the performance of the electrical conduction system, left ventricular contractility and edema, after being subjected to ischemic arrest and reperfusion.Methods: Hearts isolated from male Wistar (n=32) rats were prepared using Langendorff method and randomly divided equally into four groups according the cardioprotective solutions used Krebs-Henseleit-Buffer (KHB), Bretschneider-HTK (HTK), St. Thomas-1 (STH-1) and Celsior (CEL). After stabilization with KHB at 37°C, baseline values (control) were collected for heart rate (HR), left ventricle systolic pressure (LVSP), maximum first derivate of rise left ventricular pressure (+dP/dt), maximum first derivate of fall left ventricular pressure (-dP/dt) and coronary flow (CF). The hearts were then perfused at 10°C for 5 min and kept for 2 h in static ischemia at 20°C in each cardioprotective solution. Data evaluation was done using analysis of variance in completely randomized One-Way ANOVA and Tukey's test for multiple comparisons. The level of statistical significance chosen was P<0.05.Results: HR was restored with all the solutions used. The evaluation of left ventricular contractility (LVSP, +dP/ dt and -dP/dt) showed that treatment with CEL solution was better compared to other solutions. When analyzing the CF, the HTK solution showed better protection against edema.Conclusion: Despite the cardioprotective crystalloid solutions studied are not fully able to suppress the deleterious effects of ischemia and reperfusion in the rat heart, the CEL solution had significantly higher results followed by HTK>KHB>STH-1.

Optimization of ultrasonic-assisted extraction of pigment from Dioscorea cirrhosa by response surface methodology and evaluation of its stability

“…Among these non-conventional methods, UAE has been applied to many plant products for its ability to enhance the solvent penetration and increase the solid-liquid contact area due to the solvent cavitation effect, then the effective components can be extracted. 8 The extraction yield of avonoids by UAE could reached up to 17.2%, which was much higher than that extracted by heated, microwaves-assisted and enzyme-assisted extractions. 9 During the extraction of hesperidin from penggan peel 10 or hemicellulose from grape pomace, 11 the UAE was more effective than the conventional procedures.…”

Bicarbonate Increases Ischemia-Reperfusion Damage by Inhibiting Mitophagy

“…Indeed, the use of bicarbonate to adjust the pH and its presence in crystalloids used in reperfusion treatment is common norm in clinical settings and accepted as inoffensive. There are several types of reperfusion solutions, with specific pH, varying salts, bicarbonate and other additions, but only a few studies comparing them [40,41]. Particularly in ischemia/reperfusion injury, where bicarbonate content is known to vary considerably [42] and the main component of the damage occurs during reperfusion time [1,43], the solution chosen for reperfusion may greatly affect treatment and results.…”

Adjuvant Cardioprotection in Cardiac Surgery: Update

“…Additives are not part of every cardioplegic solution, because they are accompanied by side effects [12]. An alternative to the hyperkalaemic depolarisation arrest is the hyperpolarisation arrest induced by decreasing sodium and calcium from solutions such as Bretschneider solution and its later version, Custodiol HTK (histidine-tryptophan-ketoglutarate solution), but even this approach does not lead to a qualitative change in myocardial protection from reperfusion injury [2]. Hyperpolarisation can also be induced by agents that open membrane potassium channels (outflow of potassium from myocytes).…”

“…These groups of patients have a higher incidence of postoperative complications (acute heart/renal failure, cerebral stroke) and ultimately a higher mortality. One factor to consider involves the current limits for perioperative myocardial protection [2, 3]. Some patients may be offered revascularisation on the beating heart, transcatheter implantation of heart valve prosthesis, or a mitral clip, but for the surgical field to be peaceful and bloodless, the majority of high-risk patients are operated on using the so-called ischaemic cardioplegic arrest.…”