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Apoptosis and cardiopulmonary bypass
Miljenko Kovacević1, Ognjen Simić, Nives Jonjić
1Department of Cardiac Surgery, University Hospital Rijeka, Rijeka, Croatia. m.kovacevic@inet.hr
Journal of Cardiac Surgery
|March 7, 2007
Summary
Coronary artery bypass surgery increases myocyte apoptosis, indicated by elevated apoptotic index (AI) and Bak protein expression. Bak protein may serve as a marker for ischemia-induced injury.
Area of Science:
- Cardiovascular Surgery
- Cellular Biology
- Pathology
Background:
- Coronary artery bypass surgery (CABS) involves managing myocardial ischemia and reperfusion.
- Apoptosis, or programmed cell death, is a critical cellular process.
- Understanding apoptosis during CABS is vital for patient outcomes.
Purpose of the Study:
- To quantify the percentage of apoptotic myocytes in patients undergoing CABS.
- To compare the apoptotic index (AI) using the TUNEL method with Bak protein expression.
- To investigate the pathway of apoptosis in ischemic reperfusion injury.
Main Methods:
- Myocardial samples were collected from 20 CABS patients at three surgical stages.
- Apoptotic index (AI) was determined using the in situ terminal deoxynucleotidyl transferase-labeled dUTP nick end labeling (TUNEL) method.
- Bak protein expression was assessed via immunohistochemistry, with statistical analysis using Friedman ANOVA, Kendall coefficient of concordance, and Wilcoxon matched pair test.
Main Results:
- Bak protein expression and AI increased significantly from pre-cannulation to post-reperfusion.
- Mean Bak expression rose from 2.61 to 8.89, and AI increased from 5.38 to 15.6.
- A significant positive correlation (p > 0.0001) was found between AI and Bak protein expression.
Conclusions:
- Apoptosis is activated via the mitochondrial pathway in ischemic reperfusion injury during CABS.
- Ischemic reperfusion injury elevates the apoptotic index in right atrial tissue.
- Immunohistochemical expression of Bak protein can serve as a marker for myocardial ischemia-induced injury.
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