Transcardiac release of soluble adhesion molecules during coronary artery bypass grafting: effects of crystalloid and blood cardioplegia.
BACKGROUND
Dysfunction of myocardium as a result of ischemia/reperfusion during coronary artery bypass grafting (CABG) is currently one of the biggest problems in cardiovascular surgery. In previous studies, it has been well established that activated leukocytes and coronary vascular endothelial cells play an important role in the development of cardiac tissue damage during ischemia followed by reperfusion. Interactions between both of these cell types require the expression of adhesion molecules on their surface. In certain conditions, on cell activation, the adhesion proteins may be released from activated cells in soluble form into circulation. The purpose of our study was to establish whether the use of blood cardioplegia modifies plasma levels of soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), and soluble L-selectin (sL-selectin) in comparison with crystalloid cardioplegia in patients undergoing CABG.


METHODS
Patients undergoing CABG were classified into two groups to receive cold crystalloid cardioplegia (St. Thomas' Hospital) or cold blood cardioplegia (method of Buckberg), followed by a "warm-shot" of the solution. Coronary sinus and arterial blood samples were obtained from 50 patients (42 men and 8 women; age range, 34 to 73 years) before aortic cross-clamping, at the beginning of reperfusion, and after 30 min of reperfusion. Plasma levels of soluble adhesion molecules were measured using sensitive enzyme-linked immunosorbent assays.


RESULTS
The transcardiac release of sICAM-1 and sVCAM-1 following myocardial ischemia/reperfusion during CABG was evident in both groups of patients. However, the increase of soluble forms of both of these adhesion proteins was more significant in the group of patients receiving crystalloid cardioplegia. Crystalloid cardioplegia resulted in decreased plasma level of sE-selectin in the coronary sinus blood sample after 30 min of reperfusion. No significant changes in plasma levels of sL-selectin in either group were observed.


CONCLUSIONS
Cardioplegia may affect the release of soluble forms of adhesion molecules from ischemic myocardium and modify endothelium activation in patients undergoing CABG.
Kalawski
Ryszard
R
Department of Cardiac Surgery, J. Strus Hospital Poland, Poznan, Poland.
Majewski
Marcin
M
Kaszkowiak
Eugeniusz
E
Wysocki
Henryk
H
Siminiak
Tomasz
T
D000328:Adult; D000368:Aged; D001639:Bicarbonates; D001769:Blood; D002122:Calcium Chloride; D002314:Cardioplegic Solutions; D015815:Cell Adhesion Molecules / Q000097:blood / Q000378:metabolism*; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000378:metabolism; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D019041:L-Selectin / Q000097:blood; D008274:Magnesium; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000378:metabolism*; D018375:Neutrophil Activation; D009504:Neutrophils / Q000378:metabolism; D011189:Potassium Chloride; D012965:Sodium Chloride; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D001639:Bicarbonates; D002314:Cardioplegic Solutions; D015815:Cell Adhesion Molecules; D019040:E-Selectin; C041711:St. Thomas' Hospital cardioplegic solution; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D019041:L-Selectin; D012965:Sodium Chloride; D011189:Potassium Chloride; D008274:Magnesium; D002122:Calcium Chloride