Myocardial metabolic changes during pediatric cardiac surgery: A randomized study of 3 cardioplegic techniques

Modi, Paul; Suleiman, M‐Saadeh; Reeves, BC; Pawade, Ash; Parry, A.; Angelini, Gianni; Caputo, Massimo

doi:10.1016/j.jtcvs.2003.11.071

Cited by 72 publications

(68 citation statements)

References 28 publications

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“…We have also shown that while for acyanotic patients the cardioplegic technique is not critical, for cyanotic patients, the use of cold blood cardioplegia with terminal warm blood cardioplegic reperfusion ("hot shot") improves the metabolic and functional recovery. The hot shot cardioplegia resulted in higher reperfusion ATP, ATP/ADP and glutamate levels than acyanotic patients, suggesting that this technique is advantageous only in stressed hearts [76]. Furthermore, the study shows that even if the blood cardioplegia is kept at cold temperature, this still offers a higher myocardial protection, compared to the crystalloid cardioplegia, confirming previous experimental and clinical results [77][78][79].…”

Section: Strategies Of Surgical Interventionsupporting

confidence: 83%

Hypoxia-Induced Molecular and Cellular Changes in the Congenitally Diseased Heart: Mechanisms and Strategies of Intervention

Iacobazzi¹,

Caputo²,

Ghorbel³

2017

Hypoxia and Human Diseases

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Tissue hypoxia plays a critical role in the pathobiology of congenital heart diseases, especially with regard to cyanotic patients. Here, we describe the cellular and molecular mechanisms induced by hypoxia in the diseased heart, with particular attention to the metabolic and functional changes that underlie the hypoxia-induced right ventricle remodelling. The role of reactive oxygen species in transcriptomic changes, DNA damage, contractile dysfunction and extracellular matrix remodelling will be addressed. Furthermore, the reoxygenation injury, which occurs when oxygen is reintroduced upon initiation of cardiopulmonary bypass, will be discussed. This allows a better understanding of the risks associated with the reoxygenation injury in children undergoing openheart surgery and helps to improve strategies of intervention for myocardial protection.

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Section: Strategies Of Surgical Interventionsupporting

confidence: 83%

Hypoxia-Induced Molecular and Cellular Changes in the Congenitally Diseased Heart: Mechanisms and Strategies of Intervention

Iacobazzi¹,

Caputo²,

Ghorbel³

2017

Hypoxia and Human Diseases

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“…In adults, the superiority of blood over crystalloid cardioplegia was demonstrated experimentally [18], and was later demonstrated clinically in the pediatric population [15].…”

Section: Discussionmentioning

confidence: 99%

“…In the warm protocol (CPB temperature 36.5 8C), oxygenated blood from the oxygenator was injected either in the aortic root or directly in the coronary ostia simultaneously with the cardioplegic solution (each vial of 10 ml is composed of magnesium chloride 1.6 g, potassium chloride 0.6 g, procaïne chloride 0.1 g, aqua ad 10 ml) given at a rate of 1-1.5Â the estimated physiologic coronary flow (5% of the cardiac output) for 1 min and repeated every 15 min [15]. The hematocrit was maintained at 25% in the cold protocol and 30% in the warm protocol and targeted to be at least 30% in both groups at discontinuation of CPB.…”

Section: Cpb Protocolmentioning

confidence: 99%

Cardiac and neurological assessment of normothermia/warm blood cardioplegia vs hypothermia/cold crystalloid cardioplegia in pediatric cardiac surgery: insight from a prospective randomized trial☆

Poncelet

Steenberghe

Moniotte

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…After the surgery, all patients were admitted to the pediatric intensive care unit (ICU) and were managed according to unit protocols (21,32).…”

Section: Methodsmentioning

confidence: 99%

Controlled reoxygenation cardiopulmonary bypass is associated with reduced transcriptomic changes in cyanotic tetralogy of Fallot patients undergoing surgery

Ghorbel

Mokhtari

Sheikh

et al. 2012

Physiological Genomics

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Ghorbel MT, Mokhtari A, Sheikh M, Angelini GD, Caputo M. Controlled reoxygenation cardiopulmonary bypass is associated with reduced transcriptomic changes in cyanotic tetralogy of Fallot patients undergoing surgery. Physiol Genomics 44: 1098-1106, 2012. First published September 18, 2012 doi:10.1152/physiolgenomics.00072.2012.-In cyanotic patients undergoing repair of heart defects, high level of oxygen during cardiopulmonary bypass (CPB) leads to greater susceptibility to myocardial ischemia and reoxygenation injury. This study investigates the effects of controlled reoxygenation CPB on gene expression changes in cyanotic hearts of patients undergoing surgical correction of tetralogy of Fallot (TOF). We randomized 49 cyanotic TOF patients undergoing corrective cardiac surgery to receive either controlled reoxygenation or hyperoxic/standard CPB. Ventricular myocardium biopsies were obtained immediately after starting and before discontinuing CPB. Microarray analyses were performed on samples, and array results validated with real-time PCR. Gene expression profiles before and after hyperoxic/standard CPB revealed 35 differentially expressed genes with three upregulated and 32 downregulated. Upregulated genes included two E3 Ubiquitin ligases. The products of downregulated genes included intracellular signaling kinases, metabolic process proteins, and transport factors. In contrast, gene expression profiles before and after controlled reoxygenation CPB revealed only 11 differentially expressed genes with 10 upregulated including extracellular matrix proteins, transport factors, and one downregulated. The comparison of gene expression following hyperoxic/standard vs. controlled reoxygenation CPB revealed 59 differentially expressed genes, with six upregulated and 53 downregulated. Upregulated genes included PDE1A, MOSC1, and CRIP3. Downregulated genes functionally clustered into four major classes: extracellular matrix/cell adhesion, transcription, transport, and cellular metabolic process. This study provides direct evidence that hyperoxic CPB decreases the adaptation and remodeling capacity in cyanotic patients undergoing TOF repair. This simple CPB strategy of controlled reoxygenation reduced the number of genes whose expression was altered following hyperoxic/standard CPB.

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Myocardial metabolic changes during pediatric cardiac surgery: A randomized study of 3 cardioplegic techniques

Abstract: For cyanotic patients (younger, with longer crossclamp times), cold blood cardioplegia with a hot shot is the best method of myocardial protection. For acyanotic patients (older, with shorter crossclamp times), cardioplegic technique is not critical.

Cited by 72 publications

References 28 publications

Hypoxia-Induced Molecular and Cellular Changes in the Congenitally Diseased Heart: Mechanisms and Strategies of Intervention

Hypoxia-Induced Molecular and Cellular Changes in the Congenitally Diseased Heart: Mechanisms and Strategies of Intervention

Cardiac and neurological assessment of normothermia/warm blood cardioplegia vs hypothermia/cold crystalloid cardioplegia in pediatric cardiac surgery: insight from a prospective randomized trial☆

Controlled reoxygenation cardiopulmonary bypass is associated with reduced transcriptomic changes in cyanotic tetralogy of Fallot patients undergoing surgery

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