Resveratrol Attenuates Degeneration and Apoptosis of Cardiomyocytes Induced by Aortic Clamping.

INTRODUCTION: Objective: To investigate the potential beneficial effects of resveratrol (RVT) against ischemia-reperfusion injury of myocardial tissue during surgical treatment of ruptured abdominal aortic aneurysm. METHODS: Four groups were established - control, ischemia/reperfusion (I/R), sham (I/R+solvent/dimethyl sulfoxide [DMSO]), and I/R+RVT. Ruptured abdominal aortic aneurysm model was used as the experimental protocol. RESULTS: In the I/R and I/R+DMSO groups, malondialdehyde (MDA) levels in myocardial tissue were found to be significantly increased compared to the control group. The MDA level in myocardial tissue was significantly decreased in the I/ R+RVT group compared to the I/R group. In I/R and I/R+DMSO groups, glutathione peroxidase (GSH) levels in myocardial tissue were found to be significantly decreased compared to the control group. The GSH level in the myocardial tissue was significantly increased in the I/R+RVT group compared to the I/R group. In the light microscope, isotropic and anisotropic band disorganized atypical cardiomyocytes in the I/R group and degenerative cardiomyocytes and edematous areas in the I/R+DMSO group were observed. Degenerative cardiomyocytes and edematous areas were decreased in the I/R+RVT group. When heart tissue sections incubated with cleaved caspase-3 primary antibodies were examined under the light microscope, apoptotic cardiomyocytes were present in I/R and I/R+DMSO groups. A decrease in the number of apoptotic cardiomyocytes was observed in the I/R+RVT group. CONCLUSION: The findings of the present study indicate that RVT exhibits protective effects against ischemia-reperfusion injury occurring in the myocardium as a distant organ as a result of abdominal aorta clamping.

Resveratrol Attenuates Degeneration and Apoptosis of Cardiomyocytes Induced by Aortic Clamping

ABSTRACT Introduction: Objective: To investigate the potential beneficial effects of resveratrol (RVT) against ischemia-reperfusion injury of myocardial tissue during surgical treatment of ruptured abdominal aortic aneurysm. Methods: Four groups were established — control, ischemia/reperfusion (I/R), sham (I/R+solvent/dimethyl sulfoxide [DMSO]), and I/R+RVT. Ruptured abdominal aortic aneurysm model was used as the experimental protocol. Results: In the I/R and I/R+DMSO groups, malondialdehyde (MDA) levels in myocardial tissue were found to be significantly increased compared to the control group. The MDA level in myocardial tissue was significantly decreased in the I/ R+RVT group compared to the I/R group. In I/R and I/R+DMSO groups, glutathione peroxidase (GSH) levels in myocardial tissue were found to be significantly decreased compared to the control group. The GSH level in the myocardial tissue was significantly increased in the I/R+RVT group compared to the I/R group. In the light microscope, isotropic and anisotropic band disorganized atypical cardiomyocytes in the I/R group and degenerative cardiomyocytes and edematous areas in the I/R+DMSO group were observed. Degenerative cardiomyocytes and edematous areas were decreased in the I/R+RVT group. When heart tissue sections incubated with cleaved caspase-3 primary antibodies were examined under the light microscope, apoptotic cardiomyocytes were present in I/R and I/R+DMSO groups. A decrease in the number of apoptotic cardiomyocytes was observed in the I/R+RVT group. Conclusion: The findings of the present study indicate that RVT exhibits protective effects against ischemia-reperfusion injury occurring in the myocardium as a distant organ as a result of abdominal aorta clamping.

Resveratrol against lung injury in an ischemia/reperfusion model of abdominal aortic rupture.

BACKGROUND: The aim of this study was to examine the effects on the lungs of ischemia/reperfusion injury in a ruptured abdominal aortic aneurysm model in rats and to investigate the potential protective effects of resveratrol. METHODS: Thirty-two male Sprague-Dawley rats were randomly divided into four groups: control, ischemia/reperfusion, sham (ischemia/ reperfusion + solvent/dimethyl sulfoxide), and ischemia/reperfusion + resveratrol. In the groups subjected to ischemia/reperfusion, following 60-min shock to the abdominal aorta, vascular clamps were attached from the levels of the infrarenal and iliac bifurcation. A total of 60-min ischemia was applied, followed by 120-min reperfusion. In the ischemia/ reperfusion + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min before ischemia and immediately after reperfusion. Malondialdehyde, glutathione, and catalase levels were analyzed and histopathological examination of the lung tissues was performed. RESULTS: Malondialdehyde levels increased in the ischemia/reperfusion and ischemia/reperfusion + dimethyl sulfoxide groups, compared to the control group, while catalase levels decreased, and no significant difference was observed in the glutathione levels. Malondialdehyde levels decreased with the administration of resveratrol, while glutathione levels increased, and catalase levels remained unchanged. The increased inflammation in interstitial spaces, thickening in the alveolar septal walls, increased numbers of cleaved caspase-3 apoptotic pneumocytes, and increased histopathological lung damage scores observed in the ischemia/reperfusion and ischemia/reperfusion + dimethyl sulfoxide groups improved with the application of resveratrol. CONCLUSION: These findings suggest that resveratrol may exhibit a protective effect in preventing acute lung injury developing due to ischemia/reperfusion in ruptured abdominal aortic aneurysm surgery by reducing oxidative damage.

Prolonged QRS independently predicts long-term all-cause mortality in patients with narrow QRS complex undergoing coronary artery bypass grafting surgery (9-year follow-up results).

AIM: We investigated the association of intermediate QRS prolongation with the long-term all-cause mortality in coronary artery bypass grafting (CABG) surgery patients with a narrow QRS complex in the preoperative electrocardiography (ECG). MATERIAL AND METHODS: A total of 221 consecutive patients with narrow QRS (< 120 ms) sinus rhythm who underwent CABG surgery were included in the study. The patients were followed up for 9.2 years postoperatively in terms of mortality outcomes. RESULTS: Follow-up data were obtained from 211 (173 men, 38 women) of 221 patients. Death occurred in 57 of them. We examined patients in the two groups according to survival outcomes. In multivariate COX regression analysis EuroSCORE (OR = 1.342, 95% CI: 1.167-1.544, p < 0.001), extent of coronary artery disease (OR = 1.768, 95% CI: 1.034-3.020, p = 0.037), QRS duration (OR = 1.029, 95% CI: 1.002-1.058, p = 0.035) and fasting glucose levels (OR = 0.992, 95% CI: 0.984-0.999, p = 0.029) were independent predictors of all-cause mortality. QRS duration > 89.5 ms determined all-cause mortality with a sensitivity of 73.7% and a specificity of 52% (OR = 2.07) due to ROC analysis. All-cause mortality was significantly higher in patients with preop QRS duration > 90 ms from the first year (c2 = 6.724, p = 0.010). CONCLUSIONS: In CABG patients with a narrow QRS complex, preoperative intermediate prolonged QRS is an independent predictor of all-cause mortality in long-term follow-up.

The Role of Vaccinium Myrtillus in the Prevention of Renal Injury in an Experimental Model of Ruptured Abdominal Aortic Aneurysm.

OBJECTIVE: To examine the biochemical and histopathological renal effects of ischemia/reperfusion (I/R) injury using a ruptured abdominal aortic aneurysm (RAAA) model in rats and to investigate the potential protective effects of whortleberry (Vaccinium myrtillus). METHODS: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups - control, sham (I/R+glycerol), I/R, and I/R+whortleberry. Midline laparotomy alone was performed in the control group. Atraumatic abdominal clamps were attached under anesthesia to the abdominal aorta beneath the level of the renal artery in the groups subjected to I/R. Sixty-minute reperfusion was established one hour after ischemia. The sham group received five intraperitoneal doses of glycerol five days before I/R. The I/R+whortleberry group received a single intraperitoneal 50 mg/kg dose diluted with saline solution five days before I/R. All animals were finally euthanized by cervical dislocation following 60-min reperfusion. RESULTS: Increases were observed in malondialdehyde (MDA) levels and tubular necrosis scores (TNS) in thin kidney tissues and in numbers of apoptotic renal tubule cells, together with a decrease in glutathione (GSH) levels, in sham and I/R groups. In contrast, we observed a decrease in MDA levels, TNS, and numbers of apoptotic renal tubule cells, and an increase in GSH levels with whortleberry treatment compared to the I/R group. CONCLUSION: Our findings suggest that whortleberry may be effective against acute kidney injury by reducing oxidative stress and apoptosis.

Tea Grape Reduces Abdominal Aortic Occlusion-Induced Lung Injury.

INTRODUCTION: Ischemia-associated mortality caused by aortic cross-clamps, as in ruptured abdominal aorta aneurysm surgeries, and reperfusion following their removal represent some of the main emergency conditions in cardiovascular surgery. The purpose of our study was to examine the potential protective effect of tea grape against aortic occlusion-induced lung injury using biochemical, histopathological, immunohistochemical, and quantitative analyses. METHODS: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups: control (healthy), glycerol + ischemia/reperfusion (I/R) (sham), I/R, and I/R + tea grape. RESULTS: Following aortic occlusion, we observed apoptotic pneumocytes, thickening in the alveolar wall, edematous areas in interstitial regions, and vascular congestion. We also observed an increase in pulmonary malondialdehyde (MDA) levels and decrease in pulmonary glutathione (GSH). However, tea grape reduced apoptotic pneumocytes, edema, vascular congestion, and MDA levels, while increased GSH levels in lung tissue. CONCLUSION: Our findings suggest that tea grape is effective against aortic occlusion-induced lung injury by reducing oxidative stress and apoptosis.

The role of vaccinium myrtillus in the prevention of renal injury in an experimental model of ruptured abdominal aortic aneurysm

Abstract Objective: To examine the biochemical and histopathological renal effects of ischemia/reperfusion (I/R) injury using a ruptured abdominal aortic aneurysm (RAAA) model in rats and to investigate the potential protective effects of whortleberry (Vaccinium myrtillus). Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups - control, sham (I/R+glycerol), I/R, and I/R+whortleberry. Midline laparotomy alone was performed in the control group. Atraumatic abdominal clamps were attached under anesthesia to the abdominal aorta beneath the level of the renal artery in the groups subjected to I/R. Sixty-minute reperfusion was established one hour after ischemia. The sham group received five intraperitoneal doses of glycerol five days before I/R. The I/R+whortleberry group received a single intraperitoneal 50 mg/kg dose diluted with saline solution five days before I/R. All animals were finally euthanized by cervical dislocation following 60-min reperfusion. Results: Increases were observed in malondialdehyde (MDA) levels and tubular necrosis scores (TNS) in thin kidney tissues and in numbers of apoptotic renal tubule cells, together with a decrease in glutathione (GSH) levels, in sham and I/R groups. In contrast, we observed a decrease in MDA levels, TNS, and numbers of apoptotic renal tubule cells, and an increase in GSH levels with whortleberry treatment compared to the I/R group. Conclusion: Our findings suggest that whortleberry may be effective against acute kidney injury by reducing oxidative stress and apoptosis.

Tea grape reduces abdominal aortic occlusion-induced lung injury

Abstract Introduction: Ischemia-associated mortality caused by aortic cross-clamps, as in ruptured abdominal aorta aneurysm surgeries, and reperfusion following their removal represent some of the main emergency conditions in cardiovascular surgery. The purpose of our study was to examine the potential protective effect of tea grape against aortic occlusion-induced lung injury using biochemical, histopathological, immunohistochemical, and quantitative analyses. Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups: control (healthy), glycerol + ischemia/reperfusion (I/R) (sham), I/R, and I/R + tea grape. Results: Following aortic occlusion, we observed apoptotic pneumocytes, thickening in the alveolar wall, edematous areas in interstitial regions, and vascular congestion. We also observed an increase in pulmonary malondialdehyde (MDA) levels and decrease in pulmonary glutathione (GSH). However, tea grape reduced apoptotic pneumocytes, edema, vascular congestion, and MDA levels, while increased GSH levels in lung tissue. Conclusion: Our findings suggest that tea grape is effective against aortic occlusion-induced lung injury by reducing oxidative stress and apoptosis.

The effects of whortleberry on ischemia reperfusion-induced myocardial injury in rats.

BACKGROUND: The aim of this study was to investigate the potential protective effect of whortleberry by examining the effects on heart tissue at the molecular level of ischemia-reperfusion injury caused by surgical repair of a ruptured abdominal aortic aneurysm. METHODS: Between May 2018 and February 2019, a total of 32 male Sprague-Dawley rats were randomly assigned into control, sham (ischemia-reperfusion+glycerol), ischemia-reperfusion, and ischemia-reperfusion+whortleberry groups. Hypovolemic shock was applied to the rats in the ischemia-reperfusion groups for one hour. The abdominal aorta was explored following midline laparotomy and atraumatic microvascular clamps were applied from the infrarenal level. Following one-hour ischemia, the clamps were removed, and reperfusion was established for two hours. In the sham group, intraperitoneal glycerol once daily was applied five days before surgery. In the whortleberry group, whortleberry treatment was administered via the intraperitoneal route five days before ischemia-reperfusion. RESULTS: The ischemia-reperfusion group exhibited a decrease in the glutathione levels and an increase in the malondialdehyde levels (p<0.01 and p<0.01, respectively). We also observed an increase in the caspase-3 positivity in cardiac myofibrils (p<0.01). Whortleberry administration lowered both malondialdehyde levels and numerical density of caspase-3 positive cardiac myofibrils, while increasing the heart tissue glutathione levels, compared to the ischemia-reperfusion alone group (p<0.01, p=0.011, and p=0.011, respectively). CONCLUSION: Whortleberry may be beneficial in preventing cardiac tissue damage caused by ischemia-reperfusion in the surgical repair of ruptured abdominal aortic aneurysms.

Our early and mid-term results for endovascular repair of abdominal aortic aneurysms.

BACKGROUND: In this study, we present our early and mid-term results of endovascular aneurysm repair in patients with infrarenal abdominal aortic aneurysms. METHODS: Between December 2011 and January 2017, a total of 154 patients (136 males, 18 females; mean age 71.7 years; range, 55 to 94 years) who underwent endovascular aneurysm repair were retrospectively analyzed. Data including demographic characteristics of the patients, pre-procedural additional diagnoses, mortality and morbidity rates, length of intensive care unit and hospital stays, amounts of blood products used, complications and reinterventions were recorded. RESULTS: Seven patients underwent intervention in the emergency setting due to aneurysm rupture, while 147 patients received elective surgery. The mean follow-up was 35 (range, 12 to 72) months, the mean length of intensive care unit stay was 1.1 (range, 1 to 4) days, and the mean length of hospital stay was 3.1 (range, 3 to 7) days. A mean 0.3 units of erythrocyte suspension was used during the treatment. Endoleak developed in 16 patients, occlusion in the graft leg in two patients, increased aneurysmal diameter in six patients, and wound healing problems in five patients. Cross femoral bypass was applied in two patients, balloon dilation in three patients, proximal extension in three patients, and distal extension in four patients. Intraoperative mortality occurred in one patient. The total mortality rate was 7% and first 30-day mortality rate was 2%. CONCLUSION: Our study results suggest that endovascular aneurysm repair has certain advantages including a low operative mortality rate, short intensive care unit and hospital stays, and less blood product use. In addition, this technique can be performed with regional anesthesia in high-risk comorbid patients.

Humoral immune response and coated or uncoated oxygenators during cardiopulmonary bypass surgery.

AIM: To investigate and compare uncoated and phosphorylcholine-coated oxygenators in terms of induction of humoral immune response during coronary artery bypass surgery. METHODS: A total of 20 consecutive patients who underwent coronary artery bypass surgery were randomly distributed into two groups according to the type of oxygenator used during surgery. Group 1 consisted of 10 patients who were operated on using phosphorylcholine-coated oxygenators. Group 2 contained 10 patients who underwent surgery using uncoated oxygenators. Blood and oxygenator fibre samples were obtained and compared in terms of immunoglobulins (IgG, IgM), complements (C3c, C4), serum total protein and albumin levels using electron microscopy and flow cytometry. RESULTS: In group 1, levels of IgM, IgG, total protein and serum albumin were significantly increased at the end of cardiopulmonary bypass (CPB) compared to those at the beginning of CPB. In group 2, C3c and C4 levels at the beginning of CPB were found to be significantly higher than at the end. Electron microscopic examination of oxygenator fibres demonstrated that phosphorylcholine-coated fibres were less likely to be adsorbed by serum proteins and complements than the uncoated fibres. CONCLUSION: Our results indicate that phosphorylcholine-coated oxygenators seemed to induce humoral immune response to a lesser extent than uncoated oxygenators during coronary artery bypass procedures.

The Role of Extra-Anatomic Bypass in the Surgical Treatment of Acute Abdominal Aortic Occlusion.

BACKGROUND: Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures. METHODS: Eighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis. RESULTS: In all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2±9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up. CONCLUSION: To conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

Sequential radial artery for coronary artery bypass grafting: five-year follow-up and evaluation with multi-detector row computed tomography.

This study was undertaken to compare early postoperative results, programmed multi-detector row computed tomography coronary angiographic patency and midterm results of revascularization by sequential radial artery grafting with those of single radial artery grafting during a five-year period. Patients were grouped as those with sequential radial artery grafts (Group A, n = 27) and single radial artery grafts (Group B, n = 26). Multi-detector row computed tomography coronary angiography was scheduled at 1 and 5 years postoperatively. Each distal anastomosis was accepted as nonfunctional if a radial artery graft was occluded proximally or there was a critical stenosis. One sequential radial artery graft and two single radial artery grafts failed in the 1-year period (p>0.05). In the 5-year period, three radial artery grafts failed in each group (p>0.05). In Group A, there was no mortality in the five-year period, but in Group B, one patient died four years after the operation due to cardiac problems (p>0.05). In addition to one death in Group B, there were three percutaneous interventions and two myocardial infarctions among the 26 patients during the five-year follow-up. In group A, among 27 patients, there were 4 percutaneous interventions and one myocardial infarction (p>0.05). Although the sample size is relatively small to be conclusive, these data suggest that sequential radial artery grafting may be considered as a method of choice for maximizing arterial graft survival and patency. Noninvasive control of sequential and single radial artery grafts with multi-detector row computed tomography is feasible with no discomfort for the patient and excellent visualization of grafts.