RESUMO
BACKGROUND: During cardiac surgery with cardiopulmonary bypass, delivery of cardioplegia solution to achieve electromechanical cardiac quiescence is obligatory. The addition of lidocaine to cardioplegia has advantages, although its consequences at a molecular level remain unclear. We performed whole-genome RNA sequencing of the human left ventricular (LV) myocardium to elucidate the differences between whole-blood (WB) cardioplegia with and without addition of lidocaine (LC) on gene expression. METHODS: We prospectively enrolled 130 patients undergoing aortic valve replacement surgery. Patients received high-potassium blood cardioplegia either with (n = 37) or without (n = 93) lidocaine. The LV apex was biopsied at baseline, and after an average of 74 minutes of cold cardioplegic arrest. We performed differential gene expression analysis for 18,258 genes between these 2 groups. Clinical and demographic variables were adjusted in the model. Gene ontology (GO) and network enrichment analysis of the retained genes were performed using g:Profiler and Cytoscape. RESULTS: A total of 1,298 genes were differentially expressed between cardioplegic treatments. Compared with the WB group, genes upregulated in the LC group were identified by network enrichment to play a protective role in ischemic injury by inhibiting apoptosis, increasing transferrin endocytosis, and increasing cell viability. Downregulated genes in the LC group were identified to play a role in inflammatory diseases, oxygen transport, and neutrophil aggregation. CONCLUSIONS: The addition of lidocaine to cardioplegia had pronounced effects on a molecular level with genes responsible for decreased inflammation, reduced intracellular calcium binding, enhanced antiapoptotic protection, augmented oxygen accessibility through transferrins, and increased cell viability showing measurable differences.
Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Parada Cardíaca Induzida/métodos , Implante de Prótese de Valva Cardíaca/métodos , Lidocaína/administração & dosagem , Centros Médicos Acadêmicos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar/métodos , Ponte Cardiopulmonar/mortalidade , Estudos de Coortes , Regulação da Expressão Gênica , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Biologia Molecular , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Resultado do TratamentoAssuntos
Corpos Estranhos , Septos Cardíacos , Agulhas , Parede Torácica , Cateterismo Cardíaco , Ecocardiografia , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Traumatismos Cardíacos/etiologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/lesões , Septos Cardíacos/cirurgia , Hematoma/etiologia , Humanos , Pessoa de Meia-Idade , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Prompt controlled reperfusion of a pulmonary allograft in a sequential double lung transplant may correct cellular ischemia prior to exposure to full hydrostatic pressures and minimize organ dysfunction. We reviewed the process of a sequential double lung transplant and describe the technique of controlled antegrade graft reperfusion of the initial implant as performed at our institution.
