Blood cardioplegia reduces oxidant burden in the ischemic and reperfused human myocardium.
In 20 patients receiving cold crystalloid cardioplegia (n = 10) or cold blood cardioplegia (n = 10) during elective coronary artery bypass grafting, the atrial myocardium was tested for glutathione-related antioxidant defenses and lipid peroxidation. In both groups, ischemia and reperfusion induced a significant increase in lipid peroxidation values (p < 0.05) that was associated with a depression of nonprotein thiol compound levels (p < 0.05). Compared with the cold crystalloid cardioplegia-treated patients, the cold blood cardioplegia-treated patients showed a lower lipid peroxidation (p < 0.05) and higher values of nonprotein thiol compounds (p < 0.05). Moreover, a significant ischemia and reperfusion-dependent activation of glutathione transferase was observed only in the cold crystalloid cardioplegia-treated patients. Selenium-dependent glutathione peroxidase and glutathione reductase activities did not change after release of the aortic cross-clamp and did not differ between the two groups. The highest postoperative plasma level of the myocardial-specific isoenzyme of creatine kinase was significantly more elevated in the cold crystalloid cardioplegia patients. Overall, these tissue biochemical features indicate a lower oxidant burden in the myocardium of cold blood cardioplegia-treated patients, a finding suggesting superior protection for the ischemic and reperfused human myocardium also through antioxidant-type mechanisms, apparently medicated by the antioxidant capacity of erythrocytes and specific plasma molecules.
Istituto di Fisiopatologia Medica, Universit' G. D'Annunzio, Facoltà di Medicina e Chirurgia, Chieti, Italy.
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Lapenna
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A
Mezzetti
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de Gioia
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SD
Pierdomenico
A M
AM
Verna
F
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Daniele
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Marzio
C
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Di Ilio
A M
AM
Calafiore
F
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Cuccurullo
D001769:Blood; D002314:Cardioplegic Solutions / Q000627:therapeutic use; D003080:Cold Temperature; D001026:Coronary Artery Bypass; D005260:Female; D005609:Free Radicals / Q000032:analysis; D005978:Glutathione / Q000032:analysis*; D005979:Glutathione Peroxidase / Q000378:metabolism; D005980:Glutathione Reductase / Q000378:metabolism; D005982:Glutathione Transferase / Q000378:metabolism; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D015227:Lipid Peroxidation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000737:chemistry* / Q000201:enzymology; D016877:Oxidants / Q000032:analysis*; D017680:Potassium Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D013438:Sulfhydryl Compounds / Q000032:analysis*
D002314:Cardioplegic Solutions; D005609:Free Radicals; D016877:Oxidants; D017680:Potassium Compounds; D013438:Sulfhydryl Compounds; C018369:potassium cardioplegic solution; D005979:Glutathione Peroxidase; D005980:Glutathione Reductase; D005982:Glutathione Transferase; D005978:Glutathione