Cardiopulmonary bypass and oxidative stress
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Published on: March 23, 2018
Mustafa Zakkar1, Gustavo Guida1, M-Saadeh Suleiman1
1Bristol Royal Infirmary, Level 7, Upper Maudlin Street, Bristol BS2 8HW, UK.
Insights
Cardiopulmonary bypass (CPB) improves cardiac surgery but causes oxidative stress. Antioxidants or modified circuits may mitigate this stress, improving organ function and patient outcomes during CPB.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Oxidative Stress Research
Background:
- Cardiopulmonary bypass (CPB) has transformed cardiac surgery, enhancing patient outcomes.
- CPB triggers coagulation, inflammation, and survival pathways, alongside an altered redox state.
- Haemolysis, ischemia, perfusion injury, and neutrophil activation during CPB are key contributors to oxidative stress.
Purpose of the Study:
- To explore strategies for mitigating oxidative stress and inflammation during CPB.
- To investigate the role of antioxidant agents and modified circuits in managing CPB-associated complications.
Main Methods:
- Review of existing literature on CPB-induced oxidative stress and inflammation.
- Analysis of potential interventions, including antioxidant administration and modified bypass circuits (e.g., minibypass).
Main Results:
- CPB-induced oxidative stress activates pro-inflammatory and pro-apoptotic pathways.
- These pathways negatively impact myocardial, pulmonary, and renal function and recovery.
- Antioxidant administration (intravenous or in cardioplegia) can reduce reactive oxygen species (ROS) and oxidative stress.
- Modified circuits like minibypass show potential in modulating inflammatory and oxidative responses.
Conclusions:
- Oxidative stress during CPB significantly impacts organ function and clinical outcomes.
- Antioxidant therapies and innovative circuit designs offer promising avenues to reduce CPB-related complications.
- Further research into these interventions is warranted to optimize patient recovery after cardiac surgery.
Abstract:
The development of the cardiopulmonary bypass (CPB) revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the activation of different coagulation, proinflammatory, survival cascades and altered redox state. Haemolysis, ischaemia, and perfusion injury and neutrophils activation during CPB play a pivotal role in oxidative stress and the associated activation of proinflammatory and proapoptotic signalling pathways which can affect the function and recovery of multiple organs such as the myocardium, lungs, and kidneys and influence clinical outcomes. The administration of agents with antioxidant properties during surgery either intravenously or in the cardioplegia solution may reduce ROS burst and oxidative stress during CPB. Alternatively, the use of modified circuits such as minibypass can modify both proinflammatory responses and oxidative stress.
