Heart Failure after Cardiac Surgery: The Role of Halogenated Agents, Myocardial Conditioning and Oxidative Stress

Abstract

Heart disease requires a surgical approach sometimes. Cardiac-surgery patients develop heart failure associated with ischemia induced during extracorporeal circulation. This complication could be decreased with anesthetic drugs. The cardioprotective effects of halogenated agents are based on pre- and postconditioning (sevoflurane, desflurane, or isoflurane) compared to intravenous hypnotics (propofol). We tried to put light on the shadows walking through the line of the halogenated anesthetic drugs’ effects in several enzymatic routes and oxidative stress, waiting for the final results of the ACDHUVV-16 clinical trial regarding the genetic modulation of this kind of drugs.

Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery—A Narrative Review

“…VA activate the intracellular signal cascade via G-protein-coupled receptors, which results in less mitochondrial Ca 2+ and more mitochondrial K + , less ROS, and a direct inhibition of the MPTPs, as well as altering the gene expression in the cardiomyocyte, leading to a transcription of anti-apoptotic genes, expression of some of the key enzymes involved in VA cardioprotection and opening the “second window” of protection [ 18 , 21 ].…”

“…Preconditioning with VA (isoflurane-before CPB, and sevoflurane before and after CPB) also prevents oxidative and nitrosative stress during CABG surgery through overexpression of antioxidant enzymes [ 21 ].…”

Possibilities of inhalation anesthetics in blocking an excessive inflammatory response: a review

“…В обзоре José Luis Guerrero-Orriach еt al. был проведен анализ того, оказывает ли продолжительное использование галогенированных анестетиков в ближайшем послеоперационном периоде кардиопротективное действие за счет снижения оксидативного стресса, аналогичное тому, которое наблюдалось при интраоперационном их использовании [55]. Были получены обнадеживающие результаты в отношении кондиционирования миокарда, вызванного галогенсодержащими агентами (севофлуран) при интраоперационном введении и поддерживающегося в ближайшем послеоперационном периоде, по сравнению с использованием анестетика пропофола внутривенно.…”

Identification of miRNAs as Biomarkers of Cardiac Protection in Non-Genetically Modified Primary Human Cardiomyocytes Exposed to Halogenated Hypnotics in an In Vitro Model of Transfection and Ischemia/Reperfusion: A New Model in Translational Anesthesia

“…Currently, there are no predictive markers of morbidity that can be used to detect patients with a high risk of suffering perioperative ischemia or arrhythmias at baseline prior to the intervention [ 2 ]. At the anesthetic level, an advance in the treatment of this group of patients is the knowledge of the cardioprotective properties of halogenated hypnotic drugs [ 3 ], described for the first time in 1986 [ 4 ].…”

“…Moreover, the miRNAs are involved in regulating various biological processes, such as cell differentiation, proliferation, apoptosis induction, and embryonic and tissue development. Recently, miRNAs have been a major focus of interest in clinical research regarding the identification of new therapeutic miRNA biomarkers that could be candidates for different pathologies, including cardiovascular diseases [ 3 ].…”