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Effect of Selective Antegrade Cerebral Perfusion with Moderately Hypothermic Lower Body Circulatory Arrest on Biomarkers Related to Endothelial Function

Yıl 2020, Cilt: 4 Sayı: 1, 48 - 55, 02.03.2020
https://doi.org/10.30565/medalanya.642337

Öz

Aim: This study aims to compare biomarkers related to endothelial function during selective antegrade cerebral perfusion with moderate hypothermic lower body circulatory arrest with that of standard cardiac surgery.

Material and Methods: Thirty-six consecutive patients who underwent selective antegrade cerebral perfusion with moderately hypothermic lower body circulatory arrest at 28°C (study group) for aneurysms of the ascending aorta were prospectively compared with 36 patients who underwent standard cardiac surgery (control group) with conventional cardiopulmonary bypass. Nitric oxide, asymmetric dimethylarginine, hydrogen sulfide and total antioxidant capacity status and lactate levels in blood specimens obtained from the vena cava inferior were studied. Clinical results and biochemical parameters were evaluated.

Results: Biomarkers related to endothelial function were found to be similar between the groups except for asymmetric dimethylarginine. The asymmetric dimethylarginine levels were lower, while lactate levels were significantly higher compared to the control group. When the patients with coronary artery disease were excluded from the analysis to rule out the predominance of coronary artery disease patients in one group as a confounding factor, the asymmetric dimethylarginine levels were found to be similar between the two subgroups.

Conclusion: Low plasma levels of asymmetric dimethylarginine in the study group may have a protective role in endothelial nitric oxide synthesis. When patients with coronary artery disease were excluded from both group, biomarkers related to endothelial function were similar in both groups. We consider that endothelial functions are not affected adversely during short periods of moderately hypothermic lower body circulatory arrest.

Kaynakça

  • 1. Kazui T. Update in surgical management of aneurysms of the thoracic aorta. Rinsho Kyobu Geka 1986;6:7-15. PMID: 9423028
  • 2. Zierer A, El-Sayed Ahmad A, Papadopoulos N, Moritz A, Diegeler A, Urbanski PP. Selective antegrade cerebral perfusion and mild (28°C-30°C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients. J Thorac Cardiovasc Surg. 2012;144:1042-49. PMID: 22967770
  • 3. Ozatik MA, Kucuker SA, Tülüce H, Sartiaş A, Sener E, Karakaş S, et al. Neurocognitive functions after aortic arch repair with right brachial artery perfusion. Ann Thorac Surg. 2004;78:591-95. PMID: 15276528
  • 4. Ozen A, Altıntaş G, Unal EU, Yilmaz M, Ozen S. Factors affecting long-term survival of patients undergoing aortic surgery using the antegrade selective cerebral perfusion technique. Turk Gogus Kalp Dama. 2014;22:13-18. doi:10.5606/tgkdc.dergisi.2014.8205.
  • 5. Leshnower BG, Thourani VH, Halkos ME, Sarin EL, Keeling WB, Lamias MJ, et al. Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection. Ann Thorac Surg. 2015;100:1563-68. PMID: 26233273
  • 6. Khaladj N, Shrestha M, Meck S, Peterss S, Kamiya H, Kallenbach K, et al. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg. 2008;135:908-14. PMID: 18374779
  • 7. Landmesser U, Hornig B, Drexler H. Endothelial function: A critical determinant in atherosclerosis. Circulation. 2004;109:27–33. PMID: 15173060
  • 8. Ho JJ, Man HS, Marsden PA. Nitric oxide signaling in hypoxia. J Mol Med. 2012;90:217-31. Doi: 10.1007/s00109-012-0880-5.
  • 9. Özden Işıklar Ö, Mutaf I. Asymmetric Dimethylarginine and it’s Clinical Significance. Türk Klinik Biyokimya Derg. 2010;8:75-89.
  • 10. Wagner F, Asfar P, Calzia E, Radermacher P, Szabó C. Bench-to-bedside review: Hydrogen sulfide the third gaseous transmitter: applications for critical care. Crit Care. 2009;13:213-22. PMID: 19519960
  • 11. Taddei S, Virdis A, Ghiadoni L, Salvetti G, Bernini G, Magagna A, et al. Age-related reduction of NO availability and oxidative stress in humans. Hypertension. 2001;38:274-79. PMID: 11509489
  • 12. Cooper WA, Duarte IG, Thourani VH, Nakamura M, Wang NP, Brown WM, et al. Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis. Ann Thorac Surg. 2000;69:696–703. PMID: 10750746
  • 13. Navarro-Gonzalvez J, Garcia-Benayas C, Arenas J. Semiautomated measurement of nitrate in biological fluids. Clin Chem. 1998;44:679-81. PMID: 9510886 14. Usanmaz SE, Demirel Yilmaz E. A microplate based spectrophotometric method for the determination of the total antioxidant capacity of human plasma: modified cupric reducing ability assay. Fund & Clin Pharmacol. 2008;22:67.
  • 15. Zhang H, Moochhala SM, Bhatia M. Endogenous hydrogen sulfide regulates inflammatory response by activating the ERK pathway in polymicrobial sepsis. J Immunol. 2008;181:4320-31. PMID: 18768890
  • 16. Kamiya H, Hagl C, Kropivnitskaya I, Böthig D, Kallenbach K, Khaladj N, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007;133:501-09. PMID: 17258589
  • 17. Tian DH, Wan B, Bannon PG, Misfeld M, LeMaire SA, Kazui T, et al. A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. Ann Cardiothorac Surg. 2013;2:148-58. PMID: 23977575
  • 18. Luehr M, Bachet J, Mohr FW, Etz CD. Modern temperature management in aortic arch surgery: the dilemma of moderate hypothermia. Eur J Cardiothorac Surg. 2014;45:27-39. PMID: 23628950
  • 19. Pacini D, Leone A, Di Marco L, Marsilli D, Sobaih F, Turci S, et al. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg. 2007;31:618-22. PMID: 17254793
  • 20. Pacini D, Pantaleo A, Di Marco L, Leone A, Barberio G, Murana G, et al. Visceral organ protection in aortic arch surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg. 2014;46:438-43. PMID: 24493060
  • 21. Ohata T, Sawa Y, Kadoba K, Kagisaki K, Suzuki K, Matsuda H. Role of nitric oxide in a temperature dependent regulation of systemic vascular resistance in cardiopulmonary bypass. Eur J Cardiothorac Surg. 2000;18:342-47. PMID: 10973545
  • 22. Özcan G, Şahin EA, Demirel Yilmaz E. Effect of Nitric Oxide on Cardiac Functions: Review. Turkiye Klinikleri J Cardiovasc Sci. 2016;28:99-117. doi: 10.5336/cardiosci.2016-53254
  • 23. Omar SA, Webb AJ. Nitrite reduction and cardiovascular protection. J Mol Cell Cardiol. 2014;73:57-69. PMID:24486197
  • 24. Xuan C, Tian QW, Li H, Zhang BB, He GW, Lun LM. Levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and risk of coronary artery disease: A meta-analysis based on 4713 participants. Eur J Prev Cardiol. 2016;23:502-10. PMID: 25956428
  • 25. Szabo C. Medicinal chemistry and therapeutic applications of the gasotransmitters NO, CO, and H2S and their prodrugs. In: Burger’s Medicinal Chemistry and Drug Discovery. Hoboken, NJ: John Wiley & Sons, 2010:265–368. doi:10.1002/0471266949.bmc178.
  • 26. Dursun M, Otunctemur A, Ozbek E, Sahin S, Besiroglu H, Ozsoy OD,et al. Protective effect of hydrogen sulfide on renal injury in the experimental unilateral ureteral obstruction. Int Braz J Urol. 2015;41:1185-93. PMID: 26742979
  • 27. Bełtowski J, Hypoxia in the renal medulla: implications for hydrogen sulfide signaling. J Pharmacol Exp Ther. 2010;334:358-64. PMID: 20427475
  • 28. Calvert JW, Coetzee WA, Lefer DJ. Novel insights into hydrogen sulfide mediated cytoprotection, Antioxid. Redox Signal. 2010;12:1203-07. PMID: 19769484
  • 29. Altaany Z, Moccia F, Munaron L, Mancardi D, Wang R. Hydrogen sulfide and endothelial dysfunction: relationship with nitric oxide. Curr Med Chem. 2014;21:3646-61. PMID: 25005182
  • 30. Sivarajah A, Collino M, Yasin M, Benetti E, Gallicchio M, Mazzon E, et al. Antiapoptotic and anti-inflammatory effects of hydrogen sulfide in a rat model of regional myocardial I/R. Shock. 2009;31:267-74. PMID: 18636044

Antegrad Serebral Perfüzyon ve Distal Ilımlı Hipotermik Sirkülatuar Arrest Tekniğinin Endotel Fonksiyonuna İlişkin Biyobelirteçler Üzerine Etkisi

Yıl 2020, Cilt: 4 Sayı: 1, 48 - 55, 02.03.2020
https://doi.org/10.30565/medalanya.642337

Öz

Amaç: Bu çalışma, antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuararrest tekniğinin endotel fonksiyonuna ilişkin biyobelirteçler üzerine etkisini standart kalp cerrahisi ile karşılaştırmayı amaçlamaktadır.

Materyal-Metod: Asendan aort anevrizması için 28 ° C' da selektif antegrad serebral perfüzyon ve orta derecede hipotermik alt vücut dolaşım durması uygulanan 36 hasta (standart çalışma grubu), konvansiyonel kardiyopulmoner bypass ile standart kalp ameliyatı uygulanan (kontrol grubu) 36 hasta prospektif olarak karşılaştırıldı. Vena kava inferiordan elde edilen kan örneklerinde nitrik oksit, asimetrik dimetilarginin, hidrojen sülfit ve toplam antioksidan kapasite durumu ve laktat seviyeleri incelenmiştir. Klinik sonuçlar ve biyokimyasal parametreler değerlendirildi.

Bulgular: Endotel fonksiyonuyla ilgili biyobelirteçler, asimetrik dimetilarjinin dışındaki gruplar arasında benzer bulundu. Asimetrik dimetilarjinin düzeyleri düşüktü, laktat düzeyleri ise kontrol grubuna göre anlamlı derecede yüksek bulundu. Kontrol gruptaki koroner arter hastalarının baskınlığını nedeniyle çıkan sonuçlarda kafa karıştırıcı bir faktör olarak düşünülerek koroner arter hastaları analiz dışında bırakıldığında, asimetrik dimetilarjinin düzeylerinin, iki alt grup arasında benzer olduğu bulundu.

Sonuç: Çalışma grubundaki düşük plazma asimetrik dimetilarjinin seviyeleri, endotelyal nitrik oksit sentezinde koruyucu bir role sahip olabilir. Koroner arter hastalığı olan hastalar her iki gruptan da dışlandığında, endotel fonksiyonuna bağlı biyobelirteçler her iki grupta da benzerdi. Bu sebeple antegrad serebral perfüzyon ve distal ılımlı hipotermik sirkülatuar arrest tekniğinin kısa dönemde endotel fonksiyonlarını etkilemediğini düşünmekteyiz.

Kaynakça

  • 1. Kazui T. Update in surgical management of aneurysms of the thoracic aorta. Rinsho Kyobu Geka 1986;6:7-15. PMID: 9423028
  • 2. Zierer A, El-Sayed Ahmad A, Papadopoulos N, Moritz A, Diegeler A, Urbanski PP. Selective antegrade cerebral perfusion and mild (28°C-30°C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients. J Thorac Cardiovasc Surg. 2012;144:1042-49. PMID: 22967770
  • 3. Ozatik MA, Kucuker SA, Tülüce H, Sartiaş A, Sener E, Karakaş S, et al. Neurocognitive functions after aortic arch repair with right brachial artery perfusion. Ann Thorac Surg. 2004;78:591-95. PMID: 15276528
  • 4. Ozen A, Altıntaş G, Unal EU, Yilmaz M, Ozen S. Factors affecting long-term survival of patients undergoing aortic surgery using the antegrade selective cerebral perfusion technique. Turk Gogus Kalp Dama. 2014;22:13-18. doi:10.5606/tgkdc.dergisi.2014.8205.
  • 5. Leshnower BG, Thourani VH, Halkos ME, Sarin EL, Keeling WB, Lamias MJ, et al. Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection. Ann Thorac Surg. 2015;100:1563-68. PMID: 26233273
  • 6. Khaladj N, Shrestha M, Meck S, Peterss S, Kamiya H, Kallenbach K, et al. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg. 2008;135:908-14. PMID: 18374779
  • 7. Landmesser U, Hornig B, Drexler H. Endothelial function: A critical determinant in atherosclerosis. Circulation. 2004;109:27–33. PMID: 15173060
  • 8. Ho JJ, Man HS, Marsden PA. Nitric oxide signaling in hypoxia. J Mol Med. 2012;90:217-31. Doi: 10.1007/s00109-012-0880-5.
  • 9. Özden Işıklar Ö, Mutaf I. Asymmetric Dimethylarginine and it’s Clinical Significance. Türk Klinik Biyokimya Derg. 2010;8:75-89.
  • 10. Wagner F, Asfar P, Calzia E, Radermacher P, Szabó C. Bench-to-bedside review: Hydrogen sulfide the third gaseous transmitter: applications for critical care. Crit Care. 2009;13:213-22. PMID: 19519960
  • 11. Taddei S, Virdis A, Ghiadoni L, Salvetti G, Bernini G, Magagna A, et al. Age-related reduction of NO availability and oxidative stress in humans. Hypertension. 2001;38:274-79. PMID: 11509489
  • 12. Cooper WA, Duarte IG, Thourani VH, Nakamura M, Wang NP, Brown WM, et al. Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis. Ann Thorac Surg. 2000;69:696–703. PMID: 10750746
  • 13. Navarro-Gonzalvez J, Garcia-Benayas C, Arenas J. Semiautomated measurement of nitrate in biological fluids. Clin Chem. 1998;44:679-81. PMID: 9510886 14. Usanmaz SE, Demirel Yilmaz E. A microplate based spectrophotometric method for the determination of the total antioxidant capacity of human plasma: modified cupric reducing ability assay. Fund & Clin Pharmacol. 2008;22:67.
  • 15. Zhang H, Moochhala SM, Bhatia M. Endogenous hydrogen sulfide regulates inflammatory response by activating the ERK pathway in polymicrobial sepsis. J Immunol. 2008;181:4320-31. PMID: 18768890
  • 16. Kamiya H, Hagl C, Kropivnitskaya I, Böthig D, Kallenbach K, Khaladj N, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007;133:501-09. PMID: 17258589
  • 17. Tian DH, Wan B, Bannon PG, Misfeld M, LeMaire SA, Kazui T, et al. A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. Ann Cardiothorac Surg. 2013;2:148-58. PMID: 23977575
  • 18. Luehr M, Bachet J, Mohr FW, Etz CD. Modern temperature management in aortic arch surgery: the dilemma of moderate hypothermia. Eur J Cardiothorac Surg. 2014;45:27-39. PMID: 23628950
  • 19. Pacini D, Leone A, Di Marco L, Marsilli D, Sobaih F, Turci S, et al. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg. 2007;31:618-22. PMID: 17254793
  • 20. Pacini D, Pantaleo A, Di Marco L, Leone A, Barberio G, Murana G, et al. Visceral organ protection in aortic arch surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg. 2014;46:438-43. PMID: 24493060
  • 21. Ohata T, Sawa Y, Kadoba K, Kagisaki K, Suzuki K, Matsuda H. Role of nitric oxide in a temperature dependent regulation of systemic vascular resistance in cardiopulmonary bypass. Eur J Cardiothorac Surg. 2000;18:342-47. PMID: 10973545
  • 22. Özcan G, Şahin EA, Demirel Yilmaz E. Effect of Nitric Oxide on Cardiac Functions: Review. Turkiye Klinikleri J Cardiovasc Sci. 2016;28:99-117. doi: 10.5336/cardiosci.2016-53254
  • 23. Omar SA, Webb AJ. Nitrite reduction and cardiovascular protection. J Mol Cell Cardiol. 2014;73:57-69. PMID:24486197
  • 24. Xuan C, Tian QW, Li H, Zhang BB, He GW, Lun LM. Levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and risk of coronary artery disease: A meta-analysis based on 4713 participants. Eur J Prev Cardiol. 2016;23:502-10. PMID: 25956428
  • 25. Szabo C. Medicinal chemistry and therapeutic applications of the gasotransmitters NO, CO, and H2S and their prodrugs. In: Burger’s Medicinal Chemistry and Drug Discovery. Hoboken, NJ: John Wiley & Sons, 2010:265–368. doi:10.1002/0471266949.bmc178.
  • 26. Dursun M, Otunctemur A, Ozbek E, Sahin S, Besiroglu H, Ozsoy OD,et al. Protective effect of hydrogen sulfide on renal injury in the experimental unilateral ureteral obstruction. Int Braz J Urol. 2015;41:1185-93. PMID: 26742979
  • 27. Bełtowski J, Hypoxia in the renal medulla: implications for hydrogen sulfide signaling. J Pharmacol Exp Ther. 2010;334:358-64. PMID: 20427475
  • 28. Calvert JW, Coetzee WA, Lefer DJ. Novel insights into hydrogen sulfide mediated cytoprotection, Antioxid. Redox Signal. 2010;12:1203-07. PMID: 19769484
  • 29. Altaany Z, Moccia F, Munaron L, Mancardi D, Wang R. Hydrogen sulfide and endothelial dysfunction: relationship with nitric oxide. Curr Med Chem. 2014;21:3646-61. PMID: 25005182
  • 30. Sivarajah A, Collino M, Yasin M, Benetti E, Gallicchio M, Mazzon E, et al. Antiapoptotic and anti-inflammatory effects of hydrogen sulfide in a rat model of regional myocardial I/R. Shock. 2009;31:267-74. PMID: 18636044
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Emre Kubat 0000-0002-9884-8565

Aytaç Çalışkan Bu kişi benim 0000-0001-9223-0687

Ertekin Utku Ünal 0000-0002-1144-8906

Suzan Emel Usanmaz Bu kişi benim 0000-0002-7096-1347

Başak Soran Türkcan 0000-0002-0694-5211

Ahmet Sarıtaş Bu kişi benim 0000-0003-0748-4311

Emine Demirel-yılmaz Bu kişi benim 0000-0002-2476-6225

Ayşen İrez Aksöyek Bu kişi benim 0000-0001-7306-0459

Yayımlanma Tarihi 2 Mart 2020
Gönderilme Tarihi 4 Kasım 2019
Kabul Tarihi 9 Aralık 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 4 Sayı: 1

Kaynak Göster

Vancouver Kubat E, Çalışkan A, Ünal EU, Usanmaz SE, Soran Türkcan B, Sarıtaş A, Demirel-yılmaz E, İrez Aksöyek A. Effect of Selective Antegrade Cerebral Perfusion with Moderately Hypothermic Lower Body Circulatory Arrest on Biomarkers Related to Endothelial Function. Acta Med. Alanya. 2020;4(1):48-55.

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