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Ischemic preconditioning and postconditioning in cardiovascular surgery

Yıl 2010, Cilt: 32 Sayı: 3, 365 - 373, 27.04.2010

İlker Şengül , Demet Şengül

Öz

Abstract

Despite the technical improvements in the procedures of cardiovascular surgery; significant morbidity and mortality still continue in the patients undergoing cardiovascular surgery, especially in the high risk ones. Models of “conditioning” are suggested and evaluated as preserving the heart itself against ischemia - reperfusion injury which is an important cause of miyocardial injury created by the mentioned surgery and these models have been used in lots of experimental / clinical studies. In the mechanism of ischemic preconditioning; various systemic, chemical, physical stimuli, the substances affecting on the paired receptors of G - protein, proinflammatory substances, changes in the oxygen tension and various hypotheses were suggested such as protein kinase activation and activation of miyocardial potassium-ATP (KATP) channels. Lots of affirmative cardiovascular inteventions such as coronary artery bypass surgery, cardiac valve replacement, transplantation in vivo and vitro have been reported to benefit from the miyocardial preservation effect of ischemic preconditioning. Postconditioning have been widely used in various experimental / clinical studies such as acute miyocardial infarction, ventricular defibrillation, repair of tetralogy of Fallot and transplantation. Despite the fact that these “conditioning” phenomenons are promising, the demand for larger, multicenter, randomised, placebo - controlled experimental / clinical studies in this subject is increasing day by day.

 

Key words: Cardiovascular surgical procedure; conditioning; ischemic preconditioning; postconditioning; ischemia; reperfusion.

 

Özet

Kardiyovasküler cerrahi prosedürlerinde teknik ilerlemelere rağmen, hala kardiyovasküler cerrahiye giden - özellikle yüksek riskli – hastalarda, belirgin morbidite ve mortalite süregelmektedir. Anılan cerrahinin yarattığı miyokard hasarının ileri gelen nedeni olan iskemi – reperfüzyon hasarına karşı kalbin kendini koruması olarak bakılan “koşullanma” modelleri öne sürülmüş ve deneysel / klinik birçok çalışmada kullanılmıştır. İskemik önkoşullanmanın mekanizmasında; çok miktarda sistemik, kimyasal, fiziksel uyaran, G - proteinin çiftleşmiş reseptörleri üzerine etki eden maddeler, proinflamatuvar maddeler, oksijen tansiyonundaki değişimler ile birlikte protein kinaz aktivasyonu ve miyokardiyal potasyum - ATP (KATP) kanal aktivasyonu gibi daha birçok hipotez ileri sürülmüştür. İskemik önkoşullanmanın miyokard koruyuculuğu eylemi ile ilgili in vivo ve in vitro olmak üzere koroner arter “bypass” cerrahisi, kalp kapak replasmanı, transplantasyon gibi birçok olumlu kardiyovasküler cerrahi girişim raporlanmıştır. Sonradan koşullanma ise akut miyokard infarktüsü, ventriküler defibrilasyon, Fallot tetralojisi onarımı ve transplantasyon gibi alanlardaki deneysel / klinik birçok çalışmada geniş kullanım alanı bulmuştur. Bununla birlikte; bu “koşullanma” fenomenleri umut verici olsa da daha geniş, çok merkezli, randomize, placebo - kontrollü, deneysel ve klinik çalışmalara gereksinim gün geçtikçe artmaktadır.

 

Anahtar sözcükler: Kardiyovasküler cerrahi prosedür; koşullanma; iskemik önkoşullanma; sonradan koşullanma; iskemi; reperfüzyon.

Anahtar Kelimeler

-

Kaynakça

  • Valen G, Vaage J. Pre- and postconditioning during cardiac surgery. Basic Res Cardiol 2004-5;100:179-86.
  • Domenech R, Macho P. Non- ischemic myocardial preconditioning. Mol Cell Biochem 1998;186:201-3.
  • Yellon MD, Downey JM. Preconditioning the myocardim: from cellular physiology to clinical cardiology. Physiol Rev 2003;83:1113-51.
  • Sivaraman V, Hausenloy DJ, Kolvekar S, Hayward M, Yap J, Lawrence D, Di Salvo C, Yellon DM. The divergent roles of protein kinase C epsilon and delta in simulated ischaemia-reperfusion injury in human myocardium. J Mol Cell Cardiol 2009; 46: 758- 64.
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ISCHEMIC PRECONDITIONING AND POSTCONDITIONING IN CARDIOVASCULAR SURGERY

Yıl 2010, Cilt: 32 Sayı: 3, 365 - 373, 27.04.2010

İlker Şengül , Demet Şengül

Öz

Although the technical developments in the procedures of cardiovascular surgery; significant morbidity and mortality stil continue in the patients undergoing cardiovascular surgery, especially in the high risk ones. Models of “conditioning” are suggested and evaluated as preserving the heart itself against ischemia – reperfusion injury which is an important cause of miyocardial injury is created by the mentioned surgery and they are used in lots of experimental / clinical study. In the mechanism of ischemic preconditioning; lots of systemic, chemical, physical stimulus, the substances affecting on the paired receptors of G – protein, proinflammatuar substances, changings in the tension of oxygen with the plenty of hypothesis such, protein kinase activation and activation of miyocardial potassium – ATP (KATP) channels are asserted. Lots of affirmative cardiovascular intevention such coronary artery bypass surgery, cardiac valve replacement, transplantation in vivo and vitro has been reported are related to act of miyocard preservation of ischemic preconditioning. Postconditioning have the area of usages in the lots of experimental / clinical study such, acute miyocardial infarction, ventricular defibrillation, repair of tetralogy of Fallot and transplantation. However, these “conditioning” phenomenons are hopeful, though the demand of larger, multidicipliner, randomised, placebo –  controlled experimental / clinical study is increasing day by day.

 

 

 

Anahtar Kelimeler

Kardiyovasküler cerrahi prosedür koşullanma iskemik önkoşullanma sonradan koşullanma iskemi reperfüzyon

Kaynakça

  • Valen G, Vaage J. Pre- and postconditioning during cardiac surgery. Basic Res Cardiol 2004-5;100:179-86.
  • Domenech R, Macho P. Non- ischemic myocardial preconditioning. Mol Cell Biochem 1998;186:201-3.
  • Yellon MD, Downey JM. Preconditioning the myocardim: from cellular physiology to clinical cardiology. Physiol Rev 2003;83:1113-51.
  • Sivaraman V, Hausenloy DJ, Kolvekar S, Hayward M, Yap J, Lawrence D, Di Salvo C, Yellon DM. The divergent roles of protein kinase C epsilon and delta in simulated ischaemia-reperfusion injury in human myocardium. J Mol Cell Cardiol 2009; 46: 758- 64.
  • Baxter GF, Ferdinandly P. Delayed preconditioning of myocardium: current perspectives. Basic Res Cardiol 2001; 96: 329-44.
  • Budas GR, Jovanovic S, Crawford RM, Jovanovic A. Hypoxia induced preconditioning in adult simulated cardiomyocytes is mediated by opening and trafficking of sarcolemmal K-ATP channel. FASEB J 2004;18: 1046-8.
  • Laude K, Beauchamp P, Thuillez C, Richard V. Endothelial effect of preconditioning. Cardiovasc Res 2002; 55: 466-73.
  • Marber MS. Ischemic preconditioning in isolated cells. Circ Res 1986;86:926-31.
  • Murphy E. Pimary and secondary signaling pathways in early preconditioning converge in mitochondria to produce cardioprotection. Circ Res 2004; 94: 7-16.
  • Gao X, Zhang H, Takahashi T, Hsieh J, Liao J, Steinberg GK, Zhao H. The Akt signaling pathway contributes to postconditioning's protection against stroke; the protection is associated with the MAPK and PKC pathways. J Neurochem 2008; 105: 943-55.
  • Rehni AK, Singh N. Role of phosphoinositide 3-kinase in ischemic postconditioning- induced attenuation of cerebral ischemia-evoked behavioral deficits in mice. Pharmacol Rep 2007; 59: 192-8.
  • Wojtovich AP, Brookes PS. The complex II inhibitor atpenin A5 protects against cardiac ischemia-reperfusion injury via activation of mitochondrial KATP channels. Basic Res Cardiol 2009; 104: 121-9.
  • Lamendola P, Di Monaco A, Barone L, Pisanello C, Lanza GA, Crea F. [Mechanisms of myocardial cell protection from ischemia/reperfusion injury and potential clinical implications]. G Ital Cardiol (Rome) 2009; 10: 28-36. [Article in Italian]
  • Valen G. Cellular signaling mechanisms in adaptaton of ischemia induced myocardial damage. Ann Med 2003; 35: 1-8.
  • Yellon DM, Dana A. The preconditioning phenomenon. A tool for scientist or a clinical reality? Circ Res 2000; 87: 543-50.
  • de Zeeuw S, Van den Doel MA, Duncker DJ, Verdouw PD. New insights into cardioprotection by ischemic preconditioning and other forms of stress. Ann N Y Acad Sci. 1999; 874: 178-91.
  • Şengül İ, Şengül D. İskemik ön koşullanma ve sonradan koşullanma mekanizmaları olarak intraselüler sinyalizasyon ve adenozin. Cumhuriyet Tıp Derg 2010; 32: 127-131.
  • Bopassa JC, Ferrera R, Gateau-Roesch O, Couture –Lepetit E, Ovize M. PI3-kinase regulates the mitochondrial transition pore in controlled reperfusion and postconditioning. Cardiovasc Res 2006; 69: 178-85.
  • Kolocassides KD, Galinanes M, Hearse D. İschemic preconditioning, cardioplegia or both? J Moll Cell Cardiol 1994; 26: 1411-14.
  • Takeshima S, Vaage J, Löwbeer C, Valen G. Does hypothermia or hypokalemia influence the preconditioning response? Scand Cardiovasc J 1999; 33: 79-87.
  • von Arnim CA, Etrich SM, Trimmler M, Riepe MV. Gender dependent hypoxic tolerance mediated via gender specific mechanisms. J Neurosci Res 2002; 68: 84-8.
  • Lee TM, Su SF, Tsai CC, LeeYT, Tsai CH. Cardioprotective effects of 17-β estradiol produced by activation of mitochondrial ATP-sensitive K channels in canine hearts. J Moll Cell Cardiol 2000; 32: 1147-58.
  • Shinmura K, Nagai M, Tamaki K, Bolli R. Gender and aging do not impare opioid- related preconditioning in rats. Basic Res Cardiol 2004; 99: 46-55.
  • Song X, Li g, Vaage J, Valen G. Effects of sex, gonadectomy and estrogen substitution on ischemic preconditioning and ischemia- reperfusion injury in mice. Acta Physiol Scand 2003; 177: 459-66.
  • Szekers L, Szilvassy Z, Ferdinandy P, Nagy I, Karcsu S, Csáti S. Delayed cardiac protection against harmfull consequences of stress can be induced in experimental atherosclerosis in rabbits. J Moll Cell Cardiol 1997; 29: 1977-83.
  • Li G, Tokuno S, Tahepold P, Vaage J, Löwbeer C, Valen G. Preconditioning protects the severely atherosclerotic mouse heart. Ann Thorac Surg 2001; 71: 1296-303.
  • Tokuna S, Hinokiyama K, Tokuna K, Löwbeer C, Valen G. Spontaneus ischemic events in the heart and brain precondition the hearts of severely atherosclerotic mice. Atheroscler Thromb Vasc Biol 2002; 22: 995-1001.
  • Mehta JL, Saldeen TGP, Rand K. Interactive role of infection, inflamation and traditional risk factors in atherosclerosis and coronary artery disease. Circ Res 1998; 31: 1217-25.
  • Abete P, Cacciatore F, Della Morte D, Mazzella F, Testa G, Galizia G, De Santis D, Longobardi G, Ferrara N, Rengo F. Joint effect of physical activity and body mass index on mortality for acute myocardial infarction in the elderly: role of preinfarction angina as equivalent of ischemic preconditioning. Eur J Cardiovasc Prev Rehabil 2009; 16: 73-9.
  • Sezer M, Nisanci Y, Umman B, Umman S, Pusuroglu H, Filorinali N, Ozsaruhan O, Erzengin F. Effect of preinfarction angina pectoris on microcirculation in patients with reperfused acute myocardial infarction. Acta Cardiol 2004; 59: 25-31.
  • Valen G, Hansson GK, Dumitrescu A, Vaage J. Unstable angina activates myocardial heart shock protein 72, endothelial nitric oxide synthase and transcription factors NFkB and AP-1. Cardiovasc Res 2000; 47: 49-56.
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  • Sbrana S, Parri MS, De Filippis R, Gianetti J, Clerico A. Monitoring of monocyte functional state after extracorporeal circulation: a flow cytometry study. Cytometry B Clin Cytom 2004; 58: 17-24.
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  • Hausenloy DJ, Mwamure PK, Venugopal V, Harris J, Barnard M, Grundy E, Ashley E, Vichare S, Di Salvo C, Kolvekar S, Hayward M, Keogh B, MacAllister RJ, Yellon DM. Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet 2007; 370: 575-9.
  • Teoh LK, Grant LR, Hulf JA, Pugsley WB, Yellon DM. The effect of preconditioning (ischemic and pharmacological) on myocardium necrosis following coronary artery bypass surgery. Cardiovasc Res 2002; 53: 175-80.
  • Wu Z-K, Tarkka M, Pehkonen E, Kaukinen L, Honkonen El, Kaukinen S. Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting, Ann Thorac Surg 2000; 70: 1551-7.
  • Wu Z-K, Tarkka M, Pehkonen E, Kaukinen L, Honkonen El, Kaukinen S. Ischemic preconditioning has beneficial effects on left ventricular hemodynamic function after coronary artery bypass grafting operation. Scand Cardiovasc J 2000; 34: 242-53.
  • Wu Z-K, Pehkonen E, Laurikka J, Kaukinen L, Honkonen El, Kaukinen S, Laippala P, Tarkka MR. The protective effects of preconditioning decline in aged patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2001; 122: 972-8.
  • Wu Z-K, Livainen T, Pehkonen E, Laurikka J, Tarkka MR. Ischemic preconditioning supresses ventricular tachyarrthmias after myocardial revascularization. Circulation 2002; 106: 3091-6.
  • Wu Z-K, Livainen T, Pehkonen E, Laurikka J, Zhang S, Tarkka MR. Fibrillation in patients subjected to coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003; 126: 1477-82.
  • Wu Z-K, Livainen T, Laurikka J, Saraste A, Kyto V, Pehkonen E, Savunen T, Tarkka MR. Cardiomyocyte apoptosis and ischemic preconditioning in open heart operations. Ann Thorac Surg 2001; 76: 528-34.
  • Wang X, Wei M, Kuukasjarvi P, Laurikka J, Jarvinen O, Rinne T, Honkonen El, Tarkka M. Novel pharmacological preconditioning with diaxozide attenuates myocardial stunning in coronary artery bypass grafting. Eur J Cardiothorac Surg 2003; 24: 967-73.
  • Venugopal V, Hausenloy DJ, Ludman A, Di Salvo C, Kolvekar S, Yap J, Lawrence D, Bognolo J, Yellon DM. Remote Ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold blood cardioplegia:a randomised controlled trial. Heart 2009; 95: 1567-71.
  • Zhao ZQ, Corvera JS, Halkos ME, Kerendi F, Wang NP, Guyton RA, Vinten-Johansen J. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am J Physiol 2003; 285: H579-88.
  • Kin H, Zhao ZQ, Sun H-Y, Wang N-P, Corvera JS, Halkos ME, Kerendi F, Guyton RA, Vinten-Johansen J. Postconditioning attenuates myocardial ischemia-reperfusion injury by inhibiting events in the early minutes of reperfusion. Cardiovasc Res 2004; 62: 74-85.
  • Hearse DJ, Bolli R. Reperfusion induced injury: manifestations, mechanisms and clinical relevalance. Cardiovasc Res 1992;256:H1719-25.
  • Zhang F, Chen G, Chen C, Yan M. Sevoflurane postconditioning converts persistent ventricular fibrillation into regular rhythm. Eur J Anaesthesiol 2009; 26: 766-71.
  • Sun K, Liu ZS, Sun Q. Role of mitochondria in cell apoptosis during hepatic ischemia- reperfüsion injury and protective effect of ischemic postconditioning. World J Gastroenterol 2004; 10: 1934-8.
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  • Danielisová V, Gottlieb M, Némethová M, Burda J. Effects of Bradykinin Postconditioning on Endogenous Antioxidant Enzyme Activity After Transient Forebrain Ischemia in Rat. Neurochem Res 2008; 33: 1057-64.
  • Xing B, Chen H, Zhang M, Zhao D, Jiang R, Liu X, Zhang S. Ischemic postconditioning inhibits apoptosis after focal cerebral ischemia/reperfusion injury in the rat. Stroke 2008; 39:2362-9.
  • Liu X, Chen H, Zhan B, Xing B, Zhou J, Zhu H, Chen Z. Attenuation of reperfusion injury by renal ischemic postconditioning: The role of NO. Biochem Biophys Res Commun 2007; 359: 628-34.
  • Szwarc I, Soullier S, Gayrard N, Mejean C, Mourad G, Argiles A. Ischemic postconditioning prevents ischemic acute renal failure. Transplant Proc 2007; 39: 2554-6.
  • Serviddio G, Romano AD, Gesualdo L, Tamborra R, Di Palma AM, Rollo T, Altomare E, Vendemiale G. Nephrol Dial Transplant 2008; 23: 1504-12.
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  • Moon JG, Lim HC, Gye MR, Oh JS, Park JW. Postconditioning attenuates ischemia- reperfusion injury in rat skin flap. Microsurgery 2008; 28: 531-7.
  • Şengül İ, Hasanoğlu A, Şengül D, Urhan MK, Taner AŞ, Güler O. Sonradan koşullanmanın; reperfüzyonun ilk dakikalarındaki olayların inhibisyonu yoluyla, intestinal iskemi-reperfüzyon hasarına etkisi. Ulusal Cerrahi Kongresi 2006, 24-28 Mayıs 2006 Antalya. Özet Kitabı P-41.
  • Santos CH, Gomes OM, Pontes JC, Miiji LN, Bispo MA. The ischemic preconditioning and postconditioning effect on the intestinal mucosa of rats undergoing mesenteric ischemia/reperfusion procedure. Acta Cir Bras 2008; 23: 22-8.
  • Liu KX, Li YS, Huang WQ, Chen SQ, Wang ZX, Liu JX, Xia Z. Immediate postconditioning during reperfusion attenuates intestinal injury. Intensive Care Med. 2009; 35: 933-42.
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  • Tsang A, Hausenley DJ, Mocanu MM, Yellon DM. Postconditioning: a form of “modified reperfusion” protects myocardium by activating Phosphatidylinositol 3-kinase- Akt pathway. Cic Res 2004; 95: 230-2.
  • Yang X-M, Proctor JB, Cui L, Krieg T, Doney JM, Cohen MV. Multiple brief coronary occlusions during early reperfusion protects rabbit hearts by targeting cell signal pathways. J Am Coll 2004; 44: 1103-10.
  • Sun YH, Wang NP, Kerendi F, Halkos ME, Kin H, Guyton RA, Vinten-Johansen J, Zhao ZQ. Hypoxic postconditioning reduce cardiomyocyte loss by inhibiting ROS generation and intracelular Ca++ overload. Am J Physiol Heart Circ Phsiol 2005; 4,1900-8.
  • Laskey WK. Brief repetitive balloon occlusion enhance reperfusion during percutaneous coronary intrvention for acute myocardial infarction: a pilot study. Catheter Cardiovasc Interv 2005; 65: 361-7.
  • Staat P, Rioufol G, Piot C, Cottin Y, Cung TT, L'Huillier I, Aupetit JF, Bonnefoy E, Finet G, André-Fouët X, Ovize M. Postconditioning in the human heart. Circulation 2005; 112: 2143-8,
  • Thibault H, Piot C, Staat P, Bontemps L, Sportouch C, Rioufol G, Cung TT, Bonnefoy E, Angoulvant D, Aupetit JF, Finet G, André-Fouët X, Macia JC, Raczka F, Rossi R, Itti R, Kirkorian G, Derumeaux G, Ovize M. Long – term benefit of postconditioning. Circulation 2008; 117: 1037-44.
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  • Li B, Chen R, Huang R, Luo W. Clinical benefit of cardiac ischemic postconditioning in corrections of tetralogy of Fallot. Interact Cardio Vasc Thorac Surg 2009; 8: 17-21.
  • Luo W, Li B, Lin G, Chen R, Huang R. Does cardioplegia leave room for postconditioning in paediatric cardiac surgery? Cardiol Young 2008; 18: 282-7.
  • Ramzy D, Rao V, Weisel RD. Clinical applicability of preconditioning and postconditioning: The cardiothoracic surgeon‟s view. Cardovasc Res 2006; 70: 174-80.
  • Venugopal V, Ludman A, Yellon DM, Hausenloy DJ. „Conditioning‟ the heart during surgery. Eur J Cardio-Thorac Surg 2009; 35: 977-87.
Toplam 85 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Derlemeler
Yazarlar

İlker Şengül

Demet Şengül

Yayımlanma Tarihi 27 Nisan 2010
Yayımlandığı Sayı Yıl 2010Cilt: 32 Sayı: 3

Kaynak Göster

AMA Şengül İ, Şengül D. Ischemic preconditioning and postconditioning in cardiovascular surgery. CMJ. Eylül 2010;32(3):365-373.