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Vascular changes after cardiac surgery: role of NOS, COX, kinases, and growth factors
Neel R Sodha1, Richard T Clements, Frank W Sellke
1Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.
Insights
Coronary artery bypass grafting uses cardioplegic arrest and cardiopulmonary bypass, causing vascular injury. This review explores how these procedures affect blood vessel signaling and potential interventions.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Complications
Background:
- Cardiovascular disease is a leading cause of death globally.
- Coronary artery bypass grafting is a critical treatment for cardiovascular disease.
- Cardiac surgeries often involve cardioplegic arrest and cardiopulmonary bypass, leading to vascular injury.
Purpose of the Study:
- To review the vascular changes induced by cardioplegia and cardiopulmonary bypass.
- To discuss the molecular mechanisms underlying these vascular dysfunctions.
- To explore therapeutic strategies for mitigating surgical vascular injury.
Main Methods:
- Literature review of studies on cardioplegia and cardiopulmonary bypass.
- Analysis of signaling pathways affected by surgical procedures.
- Examination of molecular changes in the vasculature.
Main Results:
- Cardioplegia and cardiopulmonary bypass cause iatrogenic vascular injury.
- Key affected pathways include nitric oxide signaling, cyclooxygenase activity, and growth factor expression.
- These changes result in impaired vasorelaxation/vasoconstriction, poor tissue perfusion, and edema.
Conclusions:
- Understanding the molecular basis of vascular injury is crucial for improving cardiac surgery outcomes.
- Targeting specific signaling pathways may offer therapeutic benefits.
- Further research is needed to develop effective interventions against surgical vascular damage.
Abstract:
Cardiovascular disease remains the leading cause of mortality in the industrialized world. Despite advances in pharmacotherapy and catheter based interventions, coronary artery bypass grafting remains an essential therapeutic modality. The majority of coronary artery bypass operations, as well as other cardiac surgical procedures require the use of ischemic cardioplegic arrest and cardiopulmonary bypass, both of which result in iatrogenic injury to the vasculature and microcirculation. This injury can manifest as impaired vasorelaxation or vasoconstriction, depending upon the organ system involved, resulting in impaired tissue perfusion and the development of edema. Key to this dysfunction are changes in the following: nitric oxide signaling secondary to changes in eNOS and iNOS expression and activity, cyclooxygenase function with increases in pro-inflammatory COX-2 activity, alterations in Protein Kinase C and Mitogen Activated Protein Kinase signaling, and an increase in Vascular Endothelial Growth Factor expression increasing vascular permeability and dilatation. This review discusses our current understanding of cardioplegia and cardiopulmonary bypass induced changes in the vasculature, and therapeutic interventions aimed at modulating the altered signaling pathways.
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