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Published on: February 16, 2022
Oxidative stress and nitric oxide pathway in adult patients who are candidates for cardiac surgery: patterns and
Viviana Cavalca1, Elena Tremoli, Benedetta Porro
1Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
Insights
Cardiac surgery patients exhibit elevated oxidative stress and impaired arginine/nitric oxide pathways. Mitral valve repair candidates show the most significant imbalances, indicating potential clinical implications for these cardiac surgery patients.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Surgical Research
Background:
- Oxidative stress and the arginine/nitric oxide (NO) pathway are crucial in cardiovascular health.
- Imbalances in these systems are implicated in various cardiovascular diseases and surgical outcomes.
- Understanding these pathways in cardiac surgery candidates is essential for managing perioperative risk.
Purpose of the Study:
- To investigate differences in oxidative stress and the arginine/nitric oxide pathway between healthy controls and patients undergoing common cardiac surgeries.
- To compare these physiological parameters across different surgical procedures: coronary bypass surgery, aortic valve replacement, and mitral valve repair.
Main Methods:
- Prospective observational study of 165 cardiac surgery patients and 33 healthy controls.
- Measurement of oxidative stress markers (glutathione ratio, isoprostane), antioxidants (tocopherols), and nitric oxide pathway factors (arginine, dimethylarginines) preoperatively.
- Statistical analysis using ANOVA, general linear models, and principal component analysis.
Main Results:
- Cardiac surgery patients demonstrated higher oxidative stress and lower antioxidant levels compared to controls.
- Elevated levels of the nitric oxide inhibitor asymmetric dimethylarginine were observed in surgical candidates.
- Mitral valve repair candidates exhibited greater oxidative stress and arginine/nitric oxide pathway imbalance than coronary bypass and aortic valve replacement patients.
Conclusions:
- Patients undergoing cardiac surgery show increased oxidative stress and a tendency towards impaired arginine/nitric oxide pathways.
- Mitral valve regurgitation patients present more significant perturbations in these metabolic pathways.
- Further research is needed to elucidate the clinical significance of these observed pathway alterations.
Objectives:
We investigated whether oxidative stress and the arginine/nitric oxide pathway differ in control subjects and in adult patients who are candidates for the three most common cardiac surgical operations: coronary bypass surgery, aortic valve replacement for calcific non-rheumatic aortic stenosis or mitral valve repair for degenerative mitral insufficiency.
Methods:
In this prospective observational study, we studied 165 consecutive patients undergoing surgery from January to June 2011 (coronary bypass surgery, n = 63; aortic valve replacement for calcific non-rheumatic aortic stenosis, n = 51; mitral valve repair for degenerative mitral insufficiency, n = 51). Thirty-three healthy subjects with cardiovascular risk factors similar to surgery patients were also studied (Controls). Oxidative stress (the ratio of reduced and oxidized glutathione and urinary isoprostane), antioxidants (alpha- and gamma tocopherol) and factors involved in nitric oxide synthesis (arginine, symmetric and asymmetric dimethylarginine) were measured before surgery. Analysis of variance general linear models and principal component analysis were used for statistical analysis.
Results:
Surgical patients had increased levels of oxidative stress and decreased levels of antioxidants. Increased levels of nitric oxide inhibitor asymmetric dimethylarginine were detected in surgical candidates, suggesting arginine/nitric oxide pathway impairment. Concerning the differences among surgical procedures, higher oxidative stress and a major imbalance of the ratio between substrate and inhibitors of nitric oxide synthesis were evidenced in patients who were candidates for mitral valve repair with respect to coronary bypass surgery patients and patients with calcific non-rheumatic aortic stenosis.
Conclusions:
Patients undergoing cardiac surgery have increased oxidative stress and a trend towards an impaired arginine/nitric oxide pathway with respect to Controls. Patients affected by mitral valve regurgitation show more pronounced perturbations in these pathways. The clinical implications of these findings need to be investigated.
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