Myocardial Oxidative Stress in Infants Undergoing Cardiac Surgery

Abstract

Cardiac surgery for congenital heart disease often necessitates a period of myocardial ischemia during cardiopulmonary bypass and cardioplegic arrest, followed by reperfusion after aortic cross-clamp removal. In experimental models, myocardial ischemia-reperfusion is associated with significant oxidative stress and ventricular dysfunction. A prospective observational study was conducted in infants (<1 year) who underwent elective surgical repair of a ventricular septal defect (VSD) or tetralogy of Fallot (TOF). Blood samples were drawn following anesthetic induction (baseline) and directly from the coronary sinus at 1, 3, 5, and 10 min following aortic cross-clamp removal. Samples were analyzed for oxidant stress using assays for thiobarbituric acid-reactive substances, protein carbonyl, 8-isoprostane, and total antioxidant capacity. For each subject, raw assay data were normalized to individual baseline samples and expressed as fold-change from baseline. Results were compared using a one-sample t test with Bonferroni correction for multiple comparisons. Sixteen patients (ten with TOF and six with VSD) were enrolled in the study, and there were no major postoperative complications observed. For the entire cohort, there was an immediate, rapid increase in myocardial oxidative stress that was sustained for 10 min following aortic cross-clamp removal in all biomarker assays (all P < 0.01), except total antioxidant capacity. Infant cardiac surgery is associated with a rapid, robust, and time-dependent increase in myocardial oxidant stress as measured from the coronary sinus in vivo. Future studies with larger enrollment are necessary to assess any association between myocardial oxidative stress and early postoperative outcomes.

Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes

“…The pathophysiology of OS during cardiac surgery involving CPB is multi-factorial. Systemic inflammation, mechanical shear stress, intra-operative changes in blood pressure and perfusion and significant hemodilution have been reported as possible triggers [ 1 , 2 , 15 ]. These effects can be even more profound in smaller patients given the higher proportion of the patient’s blood volume exposed to the circuit.…”

Antioxidant Therapeutic Strategies for Cardiovascular Conditions Associated with Oxidative Stress

“…Besides systemic oxidative stress, surgery-related myocardial injury in infants with congenital heart disease is of foremost importance, because these hearts almost never have a normal myocardial function and an absolutely normal anatomy is almost never achieved. In patients under 1 year of age undergoing surgical reparation of ventricular septal defect (VSD) or tetralogy of Fallot (TOF), an increase of TBARS, 8-isoprostane and protein carbonyl concentrations in coronary sinus blood after 1–3–5–10 min following aortic cross-clamp removal has been observed [ 156 ]. Accordingly, histopathological analysis of the myocardium in infants dying from heart failure after cardiac surgery show ischemic lesions that colocalize with the expression of 4-hydroxynonenal, a lipid peroxidation marker, which may imply a role of oxidative injury in the pathogenesis of these lesions [ 157 ].…”

The predictive value of Pressure Recording Analytical Method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGboost based machine learning model

“…Cardiac surgery often necessitates a period of myocardial ischemia during CBP and cardioplegic arrest, followed by reperfusion after aortic cross-clamp(ACC) removal. This myocardial ischemia-reperfusion can induce oxidative stress and ventricular dysfunction [50]. Children with prolonged DMV undergo longer CBP and ACC during the Surgery (Table 1).…”