Microvascular dysfunction following cardioplegic arrest and cardiopulmonary bypass

Feng, Jun; Kant, Shawn; Sellke, Frank W.

doi:10.20517/2574-1209.2021.57

Cited by 6 publications

(7 citation statements)

References 97 publications

(148 reference statements)

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“…Moreover, in a study conducted by Ilker M. et al, the authors analyzed endothelial injury secondary to Bretschneider infusion versus cold blood cardioplegia in 50 CABG interventions. Postoperative low levels of endothelin-1 in the crystalloid group compared to the blood cardioplegic group demonstrated lower endothelial injuries [ 56 ].…”

Section: Bretschneidermentioning

confidence: 99%

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

Ghiragosian

Harpa

Stoica

et al. 2022

JCDD

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The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the “intracellular cardioplegic” group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns have arisen regarding the effects on cardiac metabolism and postoperative myocardial functioning. This paper reviews the most important standpoints in terms of theoretical and practical analyses.

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Section: Bretschneidermentioning

confidence: 99%

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

Ghiragosian

Harpa

Stoica

et al. 2022

JCDD

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“…Microvascular dysfunction after cardiac surgery is characterized by altered myogenic and vasomotor tone as well as generalized endothelial dysfunction that, in combination, clinically manifest as systemic hypotension and organ damage ( 2 , 4 ). For example, intraoperative and postoperative inflammation in the microcirculation triggers leukocyte activation, initiating the coagulation cascade in venules.…”

Section: Introductionmentioning

confidence: 99%

Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction

et al. 2023

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Despite significant advances in surgical technique and strategies for tissue/organ protection, cardiac surgery involving cardiopulmonary bypass is a profound stressor on the human body and is associated with numerous intraoperative and postoperative collateral effects across different tissues and organ systems. Of note, cardiopulmonary bypass has been shown to induce significant alterations in microvascular reactivity. This involves altered myogenic tone, altered microvascular responsiveness to many endogenous vasoactive agonists, and generalized endothelial dysfunction across multiple vascular beds. This review begins with a survey of in vitro studies that examine the cellular mechanisms of microvascular dysfunction following cardiac surgery involving cardiopulmonary bypass, with a focus on endothelial activation, weakened barrier integrity, altered cell surface receptor expression, and changes in the balance between vasoconstrictive and vasodilatory mediators. Microvascular dysfunction in turn influences postoperative organ dysfunction in complex, poorly understood ways. Hence the second part of this review will highlight in vivo studies examining the effects of cardiac surgery on critical organ systems, notably the heart, brain, renal system, and skin/peripheral tissue vasculature. Clinical implications and possible areas for intervention will be discussed throughout the review.

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“…Post-CPB complications are largely associated with the secretion of inflammatory cytokines, such as Interleukin (IL)-1β, IL-6, IL-8 and Tumor necrosis factor alpha (TNF-α) during and after bypass [7][8][9][10][11][12][13][14][15][16] and disruption of the endothelial barrier function [17,18]. However, most current studies were based on clinical samples, which are unlikely to decouple the effects of the CPB and of the surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Monocyte Adhesion and Transmigration Through Endothelium Following Cardiopulmonary Bypass Shearing is Mediated by IL-8 Signaling

Zhou

Giachelli

et al. 2023

Preprint

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Background: The use of cardiopulmonary bypass (CPB) can induce sterile systemic inflammation that contributes to morbidity and mortality, especially in children. Patients have been found to have increased expression of cytokines and transmigration of leukocytes during and after CPB. Previous work has demonstrated that the supraphysiologic shear stresses present during CPB are sufficient to induce proinflammatory behavior in non-adherent monocytes. The interactions between shear stimulated monocytes and vascular endothelial cells have not been well studied and have important translational implications. Methods: To test the hypothesis that non-physiological shear stress experienced by monocytes during CPB affects the integrity and function of the endothelial monolayer via IL-8 signaling pathway, we have used an in vitro CPB model to study the interaction between THP-1 monocyte-like cells and human neonatal dermal microvascular endothelial cells (HNDMVECs). THP-1 cells were sheared in polyvinyl chloride (PVC) tubing at 2.1 Pa, twice of physiological shear stress, for 2 hours. Interactions between THP-1 cells and HNDMVECs were characterized after coculture. Results: We found that sheared THP-1 cells adhered to and transmigrated through the HNDMVEC monolayer more readily than static controls. When co-culturing, sheared THP-1 cells also disrupted in the VE-cadherin and led to reorganization of cytoskeletal F-actin of HNDMVECs. Treating HNDMVECs with IL-8 resulted in upregulation of vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) while also increasing the adherence of non-sheared THP-1 cells. Preincubating HNDMVECs with Reparixin, an inhibitor of CXCR2/IL-8 receptor inhibited sheared THP-1 cell adhesion to the HNDMVECs. Conclusions: These results suggested that IL-8 not only increases the endothelium permeability during monocyte migration, but also affects the initial adhesion of monocytes in a CPB setup. This study revealed a novel mechanism of post-CPB inflammation and will contribute to the development of targeted therapeutics to prevent and repair the damage to neonatal patients.

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Microvascular dysfunction following cardioplegic arrest and cardiopulmonary bypass

Cited by 6 publications

References 97 publications

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction

Monocyte Adhesion and Transmigration Through Endothelium Following Cardiopulmonary Bypass Shearing is Mediated by IL-8 Signaling

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