The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 206-214 , July 2009

The effects of normoxic versus hyperoxic cardiopulmonary bypass on oxidative stress and inflammatory response in cyanotic pediatric patients undergoing open cardiac surgery: A randomized controlled trial

  • Massimo Caputo, MD

      Affiliations

    • Bristol Heart Institute, Bristol, United Kingdom
    • Corresponding Author InformationAddress for reprints: M. Caputo, MD, Bristol Heart Institute, University of Bristol, Bristol Royal Children's Hospital, Bristol, BS2 8HW, United Kingdom.
    • ,
  • Amir Mokhtari, MRCS

      Affiliations

    • Bristol Royal Hospital for Children, Bristol, United Kingdom
    • ,
  • Chris A. Rogers, PhD

      Affiliations

    • Bristol Heart Institute, Bristol, United Kingdom
    • ,
  • Nayia Panayiotou, MSc

      Affiliations

    • Bristol Heart Institute, Bristol, United Kingdom
    • ,
  • Qiang Chen, PhD

      Affiliations

    • Bristol Royal Hospital for Children, Bristol, United Kingdom
    • ,
  • Mohamed T. Ghorbel, PhD

      Affiliations

    • Bristol Heart Institute, Bristol, United Kingdom
    • ,
  • Gianni D. Angelini, FRCS

      Affiliations

    • Bristol Heart Institute, Bristol, United Kingdom
    • ,
  • Andrew J. Parry, FRCS

      Affiliations

    • Bristol Royal Hospital for Children, Bristol, United Kingdom

Received 19 September 2008 ,Revised 21 November 2008 ,Accepted 25 December 2008.

References 

  1. Castaneda AR, Jonas RA, Mayer JE, Hanley FL. Myocardial preservation in the immature heart. Cardiac surgery of the neonate and infant. Philadelphia: Saunders; 1994;p. 41
  2. Hammon JW. Myocardial protection in the immature heart. Ann Thorac Surg. 1995;60:839–842
  3. Morita K, Ihnken K, Buckberg GD, Sherman MP, Young HH. Studies of hypoxemic/reoxygenation injury: without aortic clamping. IX. Importance of avoiding perioperative hyperoxaemia in the setting of previous cyanosis. J Thorac Cardiovasc Surg. 1995;110:1235–1244
  4. Ihnken K, Morita K, Buckberg GD, Sherman MP, Young HH. Studies of hypoxemic/reoxygenation injury: without aortic clamping. III. Comparison of the magnitude of damage by hypoxemia/reoxygenation versus ischemia/reperfusion. J Thorac Cardiovasc Surg. 1995;110:1182–1189
  5. Imura H, Caputo M, Parry A, Pawade A, Angelini GD, Suleiman MS. Age-dependent and hypoxia-related differences in myocardial protection during pediatric open heart surgery. Circulation. 2001;103:1551–1556
  6. Modi P, Imura H, Caputo M, Pawade A, Parry A, Angelini GD, et al. Cardiopulmonary bypass–induced myocardial reoxygenation in pediatric patients with cyanosis. J Thorac Cardiovasc Surg. 2002;124:1035–1036
  7. Sher PK, Hu S. Neuroprotective effect of graded reoxygenation following chronic hypoxia in neuronal cell cultures. Neuroscience. 1992;47:979–984
  8. Stauton M, Drexler C, Dulitz MG, Ekbom DC, Schmeling WT, Farber NE. Effects of hypoxia-reoxygenation on microvascular endothelial function in the rat hippocampal slice. Anaesthesiology. 1999;91:1462–1469
  9. Matheis G, Abdel-Rahman U, Braun S, Wimmer-Greinecker G, Esmaili A, Seitz U, et al. Uncontrolled reoxygenation by initiating cardiopulmonary bypass is associated with higher protein S100 in cyanotic versus acyanotic patients. Thorac Cardiovasc Surg. 2000;48:263–268
  10. Brass CA, Nunes F, Nagpal R. Increased oxyradical production during reoxygenation of perfused rat liver. Signal versus injury. Transplantation. 1994;58:1329–1335
  11. Modi P, Suleiman MS, Reeves B, Pawade A, Parry AJ, Angelini GS, et al. Myocardial metabolic changes during pediatric cardiac surgery: a randomized controlled study of three cardioplegic techniques. J Thorac Cardiovasc Surg. 2004;128:67–75
  12. Imura H, Modi P, Pawade A, Parry AJ, Suleiman MS, Angelini GD, et al. Cardiac troponin I in neonates undergoing the arterial switch operation. Ann Thorac Surg. 2002;74:1998–2002
  13. Allen BS, Rahman S, Ilbawi MN, Kronon M, Bolling KS, Halldorsson AO, et al. Detrimental effects of cardiopulmonary bypass in cyanotic infants: preventing the reoxygenation injury. Ann Thorac Surg. 1997;64:1381–1388
  14. Bulutcu FS, Bayndir O, Polat B, Yalcin Y, öZbek U, Cakali E. Does normoxemic cardiopulmonary bypass prevent myocardial reoxygenation injury in cyanotic children?. J Cardiothorac Vasc Anesth. 2002;16:330–333
  15. Ihnken K, Morita K, Buckberg GD. Studies of hypoxemic/reoxygenation injury: without aortic clamping. II. Evidence for reoxygenation damage. J Thorac Cardiovasc Surg. 1995;110:1171–1181
  16. Dhaliwal H, Kirshenbaum LA, Randhawa AK, Singal PK. Correlation between antioxidant changes during hypoxia and recovery on reoxygenation. Am J Physiol. 1991;261:H362–H368
  17. Mehlhorn U, Krahwinkel A, Geissler HJ, LaRosee K, Fischer , Klass O, et al. Nitrotyrosine and 8-isoprostane formation indicate free radical–mediated injury in hearts of patients subjected to cardioplegia. J Thorac Cardiovasc Surg. 2003;125:178–183
  18. Blasig IE, Grune T, Schönheit K. 4-Hydroxynonenal, a novel indicator of lipid peroxidation for reperfusion injury of the myocardium. Am J Physiol. 1995;269:H14–H22
  19. Delanty N, Reilly MP, Pratico D, Lawson JA, McCarthy JF, Wood AE, et al. 8-Epi PGF2{alpha} generation during coronary reperfusion: a potential quantitative marker of oxidant stress in vivo. Circulation. 1997;95:2492–2499
  20. Reilly MP, Delanty N, Roy L, Rokach J, Callaghan PO, Crean P, et al. Increased formation of the isoprostanes IPF2alpha-I and 8-epi-prostaglandin F2alpha in acute coronary angioplasty: evidence for oxidant stress during coronary reperfusion in humans. Circulation. 1997;96:3314–3320
  21. Babin-Ebell J, Roth P, Reese J, Bechtel M, Mortasawi A. Serum S100 B levels in patients after cardiac surgery: possible sources of contamination. Thorac Cardiovasc Surg. 2007;55:168–172
  22. Ali MS, Harmer M, Vaughan R. Serum 100 protein as a marker of cerebral damage during cardiac surgery. Br J Anaesth. 2000;85:287–298
  23. Ascione R, Ghosh A, Reeves BC, Arnold J, Potts M, Shah A, et al. Retinal and cerebral microembolization during coronary artery bypass surgery: a randomized, controlled trial. Circulation. 2005;112:3833–3838
  24. Videla LA. Respective roles of free radicals and energy supply in hypoxic rat liver injury after reoxygenation. Free Radic Res Commun. 1991;14:209–215
  25. Ozer J, Ratner M, Shaw M, Bailey W, Schomaker S. The current state of serum biomarkers of hepatotoxicity. Toxicology. 2008;245:194–205
  26. Beckett GJ, Hayes JD. Glutathione S-transferase measurements and liver disease in man. J Clin Biochem Nutr. 1987;2:1–24
  27. Edmunds LH. Inflammatory and immunological response to cardiopulmonary bypass. In:  Jonas RA,  Elliot MJ editor. Cardiopulmonary bypass in neonates, infants and young children. Oxford: Butterworth-Heinemann; 1994;p. 225–241
  28. Hovels-Gurich HH, Vazquez-Jimenez JF, Silvestri A, Schumacher K, Minkenberg R, Duchateau J, et al. Production of proinflammatory cytokines and myocardial dysfunction after arterial switch operation in neonates with transposition of the great arteries. J Thorac Cardiovasc Surg. 2002;124:811–820
  29. Caputo M, Bays S, Rogers C, Pawade A, Parry A, Suleiman M-S, et al. The effects of normothermic and hypothermic cardiopulmonary bypass on myocardial injury, oxidative stress, and inflammatory response in pediatric open-heart surgery: a prospective randomized study. Ann Thorac Surg. 2005;80:982–988
  30. Humphreys N, Bays SM, Parry AJ, Pawade A, Heyderman RS, Wolf AR. Spinal anesthesia with an indwelling catheter reduces the stress response in pediatric open heart surgery. Anesthesiology. 2005;103:1113–1120

 The BUPA Foundation, National Heart Research Fund, Garfield Weston Trust, and the British Heart Foundation supported this work.

 All participants in this study have seen and approved the final version and have no conflicts of interest to disclose.

PII: S0022-5223(09)00018-X

doi: 10.1016/j.jtcvs.2008.12.028

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 206-214 , July 2009

Article Tools

* Image Usage & Resolution