Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;120(7):e20220479.
doi: 10.36660/abc.20220479.

Comparison of Cardioplegic Solutions in Coronary Bypass Surgery Over Autophagy and Apoptosis Mechanisms

[Article in English, Portuguese]
Elif Funda Sener  1   2 , Zuhal Hamurcu  1   2 , Serpil Taheri  1   2 , Reyhan Tahtasakal  1   2 , Nesrin Delibasi  3 , Deniz Elcik  4 , Ecmel Mehmetbeyoglu  2 , Aydin Tuncay  5 , Fatma Dal  2 , Keziban Korkmaz Bayram  6 , Isın Gunes  7 , Omer Naci Emirogullari  5
Affiliations

Comparison of Cardioplegic Solutions in Coronary Bypass Surgery Over Autophagy and Apoptosis Mechanisms

[Article in English, Portuguese]
Elif Funda Sener et al. Arq Bras Cardiol. 2023 Jun.

Abstract
in English, Portuguese

Background: Coronary artery disease (CAD) due to myocardial ischemia causes permanent loss of heart tissue.

Objectives: We aimed to demonstrate the possible damage to the myocardium at the molecular level through the mechanisms of autophagy and apoptosis in coronary bypass surgery patients.

Methods: One group was administered a Custodiol cardioplegia solution, and the other group was administered a Blood cardioplegia solution. Two myocardial samples were collected from each patient during the operation, just before cardiac arrest and after the aortic cross-clamp was released. The expressions of autophagy and apoptosis markers were evaluated. The level of statistical significance adopted was 5%.

Results: The expression of the BECLIN gene was significant in the myocardial tissues in the BC group (p=0.0078). CASPASE 3, 8, and 9 gene expression levels were significantly lower in the CC group. Postoperative TnT levels were significantly different between the groups (p=0.0072). CASPASE 8 and CASPASE 9 gene expressions were similar before and after aortic cross-clamping (p=0.8552, p=0.8891). In the CC group, CASPASE 3, CASPASE 8, and CASPASE 9 gene expression levels were not found to be significantly different in tissue samples taken after aortic cross-clamping (p=0.7354, p=0.0758, p=0.4128, respectively).

Conclusions: With our findings, we believe that CC and BC solutions do not have a significant difference in terms of myocardial protection during bypass operations.

Fundamento: A doença arterial coronariana (DAC) devido à isquemia miocárdica causa perda permanente de tecido cardíaco.

Objetivos: Nosso objetivo foi demonstrar o possível dano ao miocárdio em nível molecular através dos mecanismos de autofagia e apoptose em pacientes submetidos à cirurgia de revascularização miocárdica.

Métodos: Um grupo recebeu uma solução de cardioplegia Custodiol e o outro grupo uma solução de cardioplegia sanguínea. Duas amostras miocárdicas foram coletadas de cada paciente durante a operação, imediatamente antes da parada cardíaca e após a liberação do pinçamento aórtico. Foram avaliadas as expressões de marcadores de autofagia e apoptose. O nível de significância estatística adotado foi de 5%.

Resultados: A expressão do gene BECLIN foi significativa nos tecidos miocárdicos do grupo CS (p=0,0078). Os níveis de expressão dos genes CASPASE 3, 8 e 9 foram significativamente menores no grupo CC. Os níveis pós-operatórios de TnT foram significativamente diferentes entre os grupos (p=0,0072). As expressões dos genes CASPASE 8 e CASPASE 9 foram semelhantes antes e depois do pinçamento aórtico (p=0,8552, p=0,8891). No grupo CC, os níveis de expressão gênica de CASPASE 3, CASPASE 8 e CASPASE 9 não foram significativamente diferentes em amostras de tecido coletadas após pinçamento aórtico (p=0,7354, p=0,0758, p=0,4128, respectivamente).

Conclusões: Com nossos achados, acreditamos que as soluções CC e CS não apresentam diferença significativa em termos de proteção miocárdica durante as operações de by-pass.

PubMed Disclaimer

Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura Central
Figura Central. : Comparação de Soluções Cardioplégicas em Cirurgia de Revascularização Miocárdica sobre Mecanismos de Autofagia e Apoptose
Figura 1
Figura 1. – Diagrama de fluxo da seleção do paciente no estudo. PCR: reação em cadeia da polimerase; RNA: ácido ribonucléico.
Figura 2
Figura 2. – A, B) Comparação dos achados laboratoriais pós-operatórios dos pacientes dos grupos Cardioplegia Custodiol e Cardioplegia Sanguínea. A) Os níveis de TnT foram significativamente diferenciados entre os grupos (p=0,0072). B) Os níveis de CK-MB não foram diferentes entre os grupos (p=0,0731). Figuras 2C-E) Gráficos de expressão. C) Imagens de Western Blot de membrana de marcadores de autofagia no grupo Cardioplegia Sanguínea e Cardioplegia Custodiol. D) Gráficos dos níveis de expressão dos genes Beclin e LC3 nas amostras de tecido miocárdico dos grupos (n=15, BO: Antes do pinçamento aórtico, AO: após a liberação do pinçamento aórtico). (*p<0,05). E) Expressões proteicas de Beclin e LC3 em ambos os grupos.
Figura 3
Figura 3. – Resultados de Western Blot. A. Imagens de Western Blot de membrana de marcadores apoptóticos no grupo Cardioplegia Sanguínea e Cardioplegia Custodiol. B. Gráficos do nível de expressão dos genes das Caspases 3, 8 e 9 nas amostras de tecido miocárdico dos grupos (n=15, BO: Antes do pinçamento aórtico, AO: após liberação do pinçamento aórtico). (*p<0,05).
Central Illustration
Central Illustration. : Comparison of Cardioplegic Solutions in Coronary Bypass Surgery Over Autophagy and Apoptosis Mechanisms
Figure 1
Figure 1. – Flow diagram of the patient selection in the study. PCR: polymerase chain reaction; RNA: ribonucleic acid.
Figure 2
Figure 2. – A, B) Comparison of the postoperative laboratory findings of the patients in Custodiol Cardioplegia and Blood Cardioplegia groups. A) TnT levels were significantly differentiated between the groups (p=0.0072). B) CK-MB levels were not different between the groups (p=0.0731). Figures 2C-E) Expression graphs. C) Western blot membrane images of autophagy markers in Blood Cardioplegia and Custodiol Cardioplegia group. D) Beclin and LC3 gene expression level graphs in myocardial tissue samples in the groups (n=15, BO: Before aortic cross-clamping, AO: after releasing aortic cross-clamping). (*p<0.05). E) Protein expressions of Beclin and LC3 in both groups.
Figure 3
Figure 3. – Western Blot Results. A) Western blot membrane images of apoptotic markers in Blood Cardioplegia and Custodiol Cardioplegia group. B) Caspase 3, 8, and 9 gene expression level graphs in myocardial tissue samples in the groups (n=15, BO: Before aortic cross-clamping, AO: after releasing aortic cross-clamping). (*p<0.05).
See this image and copyright information in PMC

References

    1. Viana FF, Shi WY, Hayward PA, Larobina ME, Liskaser F, Matalanis G. Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience. Eur J Cardiothorac Surg. 2013;43(3):526–531. doi: 10.1093/ejcts/ezs319. - DOI - PubMed
    1. Li M, Xue L, Sun H, Xu S. Myocardial Protective Effects of L-Carnitine on Ischemia-Reperfusion Injury in Patients With Rheumatic Valvular Heart Disease Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth. 2016;30(6):1485–1493. doi: 10.1053/j.jvca.2016.06.006. - DOI - PubMed
    1. Kocak EF, Kocak C, Aksoy A, Isiklar OO, Akcilar R, Ozdomanic IF, et al. High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery. Cardiovasc J Afr. 2015;26(6):234–241. doi: 10.5830/CVJA-2015-052. - DOI - PMC - PubMed
    1. Osipov RM, Robich MP, Feng J, Chan V, Clements RT, Deyo RJ, et al. Effect of hydrogen sulfide on myocardial protection in the setting of cardioplegia and cardiopulmonary bypass. Interact Cardiovasc Thorac Surg. 2010;10(4):506–512. doi: 10.1510/icvts.2009.219535. - DOI - PubMed
    1. He C, Klionsky DJ. Regulation mechanisms and signaling pathways of autophagy. Annu Rev Genet. 2009;43:67–93. doi: 10.1146/annurev-genet-102808-114910. - DOI - PMC - PubMed