Redox Signaling Biomarker and Transcription Factor Assessments Are Important to Evaluate Myocardial Protection Status...

Cardioplegias are routinely used in cardiac surgery to protect the heart from ischemia-reperfusion injury. The choice of cardioplegia depends on the surgeon's clinical expertise. No clear data demonstrate the redox-protective superiority of one cardioplegia over another. We aim to evaluate redox status and signaling assessments in coronary sinus blood samples for the different cardioplegias.

Our study included patients undergoing coronary artery bypass and isolated valve surgery. We compared blood and del Nido cardioplegia solutions. During the preoperative period, blood samples were collected from the coronary sinus both preand post-aortic cross-clamping. We also assessed redox system biomarkers and transcription factors related to the antioxidant system using spectrophotometric and immunochemical methods.

In valve patient groups that received both cardioplegia solutions, post-cross-clamping protein carbonyl levels were significantly lower compared to pre-cross-clamping values. For the levels of antioxidant system parameters, except for catalase and superoxide dismutase, no significant difference was observed for del Nido cardioplegia. Increased antioxidant enzyme levels highlight the importance of these enzymes in eliminating the higher hydroperoxide load. Regulatory proteins involved in redox signaling did not show significant variations except for Kelch-like ECH-associated protein 1 and peroxisome proliferator-activated receptor-gamma coactivator-1 alpha for cardioplegias.

Current results indicate that del Nido cardioplegia effectively protects myocardial redox status. Given these findings, despite concerns regarding its use in clinical practice, particularly in valve surgery compared to coronary artery bypass surgery, del Nido cardioplegia may provide effective myocardial protection in both coronary artery bypass and heart valve surgeries.