Sodium pump reduction correlates with aortic clamp time in pediatric heart surgery
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Published on: November 28, 2018
Mladen Pavlovic1, André Schaller, Roland A Ammann
1Division of Pediatric Cardiology, University Children's Hospital, Freiburgstrasse 23, 3010 Berne, Switzerland. mladen.pavlovic@insel.ch
Insights
In neonates and children undergoing cardiac surgery, reduced sodium pump (ATP1A1, ATP1A3) expression during cardiopulmonary bypass (CPB) correlates with myocardial injury markers, particularly in those with right atrial volume overload.
Area of Science:
- Cardiology
- Molecular Biology
- Pediatric Surgery
Background:
- Myocardial depression is a concern following cardiac surgery, influenced by cardiopulmonary bypass (CPB) and congenital heart defects.
- The sodium pump is crucial for maintaining myocardial function.
Purpose of the Study:
- To investigate the correlation between changes in sodium pump expression during CPB and clinical parameters in pediatric patients with congenital heart defects.
- To examine the expression of sodium pump isoforms alpha1 (ATP1A1) and alpha3 (ATP1A3) mRNA in atrial myocardium before and after CPB.
Main Methods:
- Right atrial myocardium samples were collected from neonates and children before and after CPB.
- Sodium pump isoforms ATP1A1 and ATP1A3 mRNA expression was quantified using RT-qPCR.
- Patients were grouped based on the presence (VO group) or absence (NO group) of right atrial volume overload.
Main Results:
- Both ATP1A1 and ATP1A3 mRNA expression significantly decreased during CPB.
- Longer aortic clamp times were associated with reduced postoperative ATP1A1 and ATP1A3 mRNA expression.
- Low postoperative expression of ATP1A1 and ATP1A3 correlated with elevated troponin-I levels, specifically in the VO group.
Conclusions:
- Sodium pump expression is reduced during CPB in pediatric cardiac surgery patients.
- Reduced sodium pump expression, particularly in patients with right atrial volume overload, is linked to myocardial injury markers like troponin-I.
- The findings highlight the susceptibility of the sodium pump to CPB in specific pediatric cardiac conditions.
Abstract:
Myocardial depression after cardiac surgery is modulated by cardiopulmonary bypass (CPB) and the underlying heart disease. The sodium pump is a key component for myocardial function. We hypothesized that the change in sodium pump expression during CPB correlates with intraoperative and postoperative laboratory and clinical parameters in neonates and children with various congenital heart defects. Sodium pump isoforms alpha1 (ATP1A1) and alpha3 (ATP1A3) mRNA expression in right atrial myocardium, excised before and after CPB, was quantified. Groups were assigned according to presence (VO group, n = 8) or absence (NO group, n = 8) of right atrial volume overload. CPB and aortic clamp time correlated with postoperative troponin-I values and ICU stay. ATP1A1 (P = 0.008) and ATP1A3 (P = 0.038) mRNA expression were significantly reduced during CPB. Longer aortic clamp times were associated with lower postoperative ATP1A1 (P = 0.045) and ATP1A3 (P = 0.002) mRNA expression. Low postoperative ATP1A1 (P = 0.043) and ATP1A3 (P = 0.002) expressions were associated with high troponin-I values. These results were restricted to the VO group. No correlation of sodium pump mRNA expression was found with the duration of ICU stay or ventilation. The postoperative troponin-I and clinical parameters correlated with the length of CPB, regardless of volume overload. In contrast, only dilated right atrium seemed to be susceptible to CPB in terms of sodium pump expression, showing a reduction during the operation and a correlation of sodium pump with postoperative troponin-I values.
