Circulation, Vol 81, 201-211, Copyright © 1990 by American Heart Association
R Ferrari, O Alfieri, S Curello, C Ceconi, A Cargnoni, P Marzollo, A Pardini, E Caradonna and O Visioli
We have investigated the relation between occurrence of myocardial
oxidative stress and functional recovery during postischemic reperfusion in
20 selected patients subjected to aortocoronary bypass grafting. Patients
were selected for having normal percent ejection fraction and left
ventricular end-diastolic pressure before the operation. Occurrence of
oxidative stress was assessed by measuring the formation and release of
oxidized glutathione (GSSG) in the coronary sinus immediately before aortic
cross-clamp, 1, 5, 10, and 20 minutes after removal of aortic cross-clamp,
and 10 and 20 minutes after the end of cardiopulmonary bypass. Reduced
glutathione (GSH), lactate, and creatine phosphokinase release were also
monitored with the same timing. Standard hemodynamic measurements were
recorded by means of a triple-lumen thermodilution pulmonary artery
catheter before sternotomy, 15 minutes after the end of cardiopulmonary
bypass, and during the 24 hours after termination of cardiopulmonary
bypass. Reperfusion in patients after a short period of ischemia (less than
30 minutes; group 1) resulted in a small and transient release in the
coronary sinus of GSSG and GSH and in a progressive improvement of
hemodynamic parameters reaching a stable state 4 hours after the operation.
In patients with a period of ischemia longer than 30 minutes (group 2),
reperfusion induced a marked and sustained release of lactate, GSH, and
GSSG; the arteriocoronary sinus difference for GSSG was still negative
after the end of cardiopulmonary bypass. The arteriocoronary sinus
difference for creatine phosphokinase also remained negative for as long as
20 minutes after cardiopulmonary bypass, and the rate of functional
recovery was significantly delayed, reaching the values of group 1 only 12
hours after the operation. In these patients there was a positive
correlation (r = 0.88, p less than 0.01) between the duration of ischemia
and the myocardial arteriovenous difference for GSSG. In addition, there
was a negative correlation between the arteriocoronary sinus difference for
GSSG and cardiac index measured 2, 4, and 6 hours after the operation.
These data suggest for the first time that, depending on the severity of
the ischemic period, oxidative stress occurs during reperfusion of patients
with coronary artery disease who are subjected to heart surgery and that it
may be linked with a delay in postoperative recovery of cardiac function.
ARTICLES
Occurrence of oxidative stress during reperfusion of the human heart
Cattedra di Cardiologia, University of Brescia, Italy.
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