CardiothoracicOxidative stress in patients undergoing cardiac surgery: comparative study of revascularization and valve replacement procedures
Introduction
An ever-increasing number of patients are undergoing cardiac surgery, involving either coronary revascularization or the replacement of heart valve structures (valve replacement) 1, 2. Both surgical procedures normally require the use of cardiopulmonary bypass (CPB) 1, 2.
It is known that CPB patients are subjected to a high degree of surgical risk 1, 2, 3, 4. In addition to the unphysiological hemodynamic conditions, one complication that may occur during CPB is the ischemia-reperfusion syndrome 3, 5, 6. During this syndrome, functional, structural and metabolic alterations are caused by a number of factors, one of which is the continuous generation of free radicals arising, among other causes, from the introduction of oxygen during reperfusion 3, 5, 6. The free radicals produced during CPB give rise to lipid peroxidation, thus damaging the cell membrane [7].
Free radicals are considered a factor responsible for systemic inflammation, one of the most significant aspects of the harmful effects of CPB and which may contribute to the development of several postoperative complications. According to some authors, free radicals are also responsible for causing reperfusion-derived arrhythmias and myocardial alteration 8, 9.
Valve replacement and coronary revascularization patients follow a similar intraoperatory procedure 1, 2, so it can be considered that both type of patients are under a similar degree of damage. However, in each group, patients present a distinct physiopathology and therefore they had different medical treatment and different associated pathologies 1, 2, which could change the response against a similar damage. This aspect has been poorly studied.
The aim of this study was to evaluate the time course of oxidative stress markers in plasma and erythrocyte from patients undergoing open heart surgery with cardiopulmonary bypass and, to examine whether the type of surgical procedure used (valve replacement or coronary revascularization) produces any differences in these makers.
Section snippets
Patients
To conduct this study, we selected 22 white male patients living in Southern Spain and considered to present a high/severe level of surgical risk, according to the Pettigrew scale, which incorporates several different indicators of the risk of surgery [10]. The patients were divided into 2 groups depending on the type of surgical intervention, the fundamental characteristics of the disease and the physicopathological problems presented (n = 11 per group). These groups comprised: 1) patients
Results
No surgery or anesthesia-related complication arose during this study. Plasma antioxidants (coenzyme Q, α-tocopherol, and retinol) are shown in Table 2. In general, a similar pattern was presented for both studied groups. Nevertheless, differences were observed between the two groups, especially with respect to the content of α-tocopherol. Thus, patients subjected to coronary revascularization presented higher α-tocopherol concentrations with statistically significant difference (P < 0.05) at
Discussion
In this study, as shown in the clinical characteristics of the patients, the groups are fairly homogeneous in composition and do not present significant differences concerning the surgical procedure in itself. The two groups were subjected to a similar degree of stress, as the intraoperatory procedure was comparable 1, 2. However, it should be noted that these patients presented different pathologies and thus received different medical treatments. This consideration could affect the organism’s
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