Potential role of endothelin receptor antagonists in the setting of cardiopulmonary bypass: relevance to myocardial performance.
The ET system is activated in cardiac surgical setting as evidenced by elevated systemic and myocardial ET-1 levels after coronary bypass grafting surgery which requires hypothermic cardioplegic arrest and cardiopulmonary bypass. Increased ET-1 may influence a number of clinical parameters in this setting. First, ET-1 may directly modulate myocardial contractile performance in the early postoperative period resulting in LV dysfunction and a complex postoperative course. Second, elevated ET-1 levels may exacerbate increased pulmonary vascular resistance and contribute to the development of transient pulmonary hypertension following bypass. Finally, augmented postoperative ET-1 levels could contribute to changes in the caliber and flow of vascular conduits used for coronary bypass. In this review, a current perspective on the ET system in the setting of cardiopulmonary bypass grafting surgery is provided and the potential use of ET receptor antagonists in this setting is discussed.
Ergul
A
A
Division of Cardiothoracic Surgery, Medical University of South Carolina, USA.
Joffs
C
C
Walker
A C
AC
Spinale
F G
FG
D000818:Animals; D002315:Cardiopulmonary Bypass; D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1 / Q000502:physiology; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006324:Heart Arrest, Induced; D006801:Humans; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology; D017466:Receptors, Endothelin / Q000502:physiology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1; D017466:Receptors, Endothelin