HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Uwe M. Fischer Paschalis Tossios Hans J. Geissler Uwe Mehlhorn Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fischer, U. M. Articles by Mehlhorn, U. Search for Related Content PubMed PubMed Citation Articles by Fischer, U. M. Articles by Mehlhorn, U. Related Collections Myocardial protection

J Thorac Cardiovasc Surg 2004;128:103-108
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Myocardial apoptosis prevention by radical scavenging in patients undergoing cardiac surgery

^a Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
^b Institute I for Anatomy, University of Cologne, Cologne, Germany

Received for publication August 20, 2003; revisions received October 10, 2003; revisions received November 6, 2003; accepted for publication December 2, 2003.

^* Address for reprints: Uwe Mehlhorn, MD, Department of Cardiothoracic Surgery, University of Cologne, Joseph-Stelzmann-Str 9, 50924 Cologne, Germany
uwe.mehlhorn{at}medizin.uni-koeln.de

BACKGROUND: Reactive oxygen-derived species, including those generated during myocardial ischemia and reperfusion induced by cardioplegia, have been suggested to be involved in myocardial apoptosis induction. The purpose of our study was to investigate (1) whether cardioplegic arrest initiates apoptosis in the hearts of cardiac surgery patients and (2) whether reactive oxygen-derived species scavenging with N-acetylcysteine attenuates myocardial apoptosis initiation.

METHODS: In transmural left ventricular biopsy samples collected before and at the end of cardiopulmonary bypass, we densitometrically determined cardiac myocyte staining intensity for active caspases-3 and -7, the apoptosis signal pathway central effector enzymes. The left ventricular biopsy samples had been obtained from 36 coronary artery bypass graft patients randomized in a double-blind fashion to receive either N-acetylcysteine (100 mg/kg into cardiopulmonary bypass prime followed by infusion at 20 mg · kg^–1 · h^–1; n = 18) or placebo (n = 18).

RESULTS: The change in left ventricular cardiac myocyte staining (end of cardiopulmonary bypass minus before cardiopulmonary bypass) differed significantly between groups for both measures: caspase-3, –3.1 ± 4.5 gray units (mean ± SD; N-acetylcysteine group) versus 7.1 ± 8.1 gray units (placebo); 95% confidence interval, 6.4 to 14.4; P < .0001; caspase-7, –5.1 ± 6.1 gray units (N-acetylcysteine) versus 5.1 ± 5.7 gray units (placebo); 95% confidence interval, 6.3 to 15.0; P < .0001. Clinical outcome did not differ between N-acetylcysteine and placebo.

CONCLUSIONS: Our data show that cardioplegic arrest initiates the apoptosis signal cascade in human left ventricular cardiac myocytes. This apoptosis induction can effectively be prevented by N-acetylcysteine.

This article has been cited by other articles:

				F. T. Lytle and D. R. Brown Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and Postoperative Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2008; 12(2): 97 - 108. [Abstract] [PDF]

				J. Zhu, R. Yin, H. Shao, G. Dong, L. Luo, and H. Jing N-acetylcysteine to ameliorate acute renal injury in a rat cardiopulmonary bypass model J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 696 - 703. [Abstract] [Full Text] [PDF]

				U. M. Fischer, C. S. Cox Jr., G. A. Laine, U. Mehlhorn, W. Bloch, and S. J. Allen Induction of cardioplegic arrest immediately activates the myocardial apoptosis signal pathway Am J Physiol Heart Circ Physiol, March 1, 2007; 292(3): H1630 - H1633. [Abstract] [Full Text] [PDF]

				I. El-Hamamsy, L.-M. Stevens, M. Carrier, M. Pellerin, D. Bouchard, P. Demers, R. Cartier, P. Page, and L. P. Perrault Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: A randomized, double-blind, placebo-controlled clinical trial J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 7 - 12. [Abstract] [Full Text] [PDF]

				U. M. Fischer, A. Antonyan, W. Bloch, and U. Mehlhorn Impact of antioxidative treatment on nuclear factor kappa-B regulation during myocardial ischemia-reperfusion Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 531 - 535. [Abstract] [Full Text] [PDF]

				B. Ramlawi, J. Feng, S. Mieno, C. Szabo, Z. Zsengeller, R. Clements, N. Sodha, M. Boodhwani, C. Bianchi, and F. W. Sellke Indices of Apoptosis Activation After Blood Cardioplegia and Cardiopulmonary Bypass Circulation, July 4, 2006; 114(1_suppl): I-257 - I-263. [Abstract] [Full Text] [PDF]

				I. Koramaz, Z. Pulathan, S. Usta, S. C. Karahan, A. Alver, E. Yaris, N. I. Kalyoncu, and F. Ozcan Cardioprotective Effect of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine During Coronary Artery Bypass Grafting Ann. Thorac. Surg., February 1, 2006; 81(2): 613 - 618. [Abstract] [Full Text] [PDF]

				H. J. Geissler and U. Mehlhorn Cold crystalloid cardioplegia MMCTS, January 9, 2006; 2006(0109): 1040. [Abstract] [Full Text] [PDF]