Microvascular Dysfunction in Patients with Diabetes After Cardioplegic Arrest and Cardiopulmonary Bypass

Overview

Journal Curr Opin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2016 Sep 23

PMID 27652811

Citations 9

Authors

Jun Feng

Frank Sellke

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: The purpose of the current review is to describe the changes of microvascular function in patients with diabetes after cardioplegic arrest and cardiopulmonary bypass (CPB) and cardiac surgery.

Recent Findings: Cardiac surgery, especially that involving cardioplegia and CPB, is associated with significant changes in vascular reactivity of coronary/peripheral microcirculation, vascular permeability, gene/protein expression, and programmed cell death, as well as with increased morbidity and mortality after surgical procedures. In particular, these changes are more profound in patients with poorly controlled diabetes.

Summary: Because alterations in vasomotor regulation are critical aspects of mortality and morbidity of cardioplegia/CPB, a better understanding of diabetic regulation of microvascular function may lead to improved postoperative outcomes of patients with diabetes after cardioplegia/CPB and cardiac surgery.

Citing Articles

Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction.

Kant S, Banerjee D, Sabe S, Sellke F, Feng J Front Med (Lausanne). 2023; 10:1110532.

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A Cardioplegic Solution with an Understanding of a Cardiochannelopathy.

Ji M, Hong J Antioxidants (Basel). 2021; 10(12).

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Glycemic control is not associated with neurocognitive decline after cardiac surgery.

Scrimgeour L, Ikeda I, Sellke N, Shi G, Feng J, Cizginer S J Card Surg. 2021; 37(1):138-147.

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Coronary endothelial dysfunction prevented by small-conductance calcium-activated potassium channel activator in mice and patients with diabetes.

Zhang Z, Shi G, Liu Y, Xing H, Kabakov A, Zhao A J Thorac Cardiovasc Surg. 2020; 160(6):e263-e280.

PMID: 32199659 PMC: 7439127. DOI: 10.1016/j.jtcvs.2020.01.078.

Enhanced Activity by NKCC1 and Slc26a6 Mediates Acidic pH and Cl Movement after Cardioplegia-Induced Arrest of db/db Diabetic Heart.

Ji M, Lee S, Lee S, Son K, Hong J Mediators Inflamm. 2019; 2019:7583760.

PMID: 31582903 PMC: 6754936. DOI: 10.1155/2019/7583760.

References

Sellke F, Shafique T, Ely D, Weintraub R . Coronary endothelial injury after cardiopulmonary bypass and ischemic cardioplegia is mediated by oxygen-derived free radicals. Circulation. 1993; 88(5 Pt 2):II395-400. View

Feng J, Liu Y, Khabbaz K, Hagberg R, Sodha N, Osipov R . Endothelin-1-induced contractile responses of human coronary arterioles via endothelin-A receptors and PKC-alpha signaling pathways. Surgery. 2010; 147(6):798-804. PMC: 2875281. DOI: 10.1016/j.surg.2009.11.016. View

Feng J, Bianchi C, Sandmeyer J, Li J, Sellke F . Molecular indices of apoptosis after intermittent blood and crystalloid cardioplegia. Circulation. 2005; 112(9 Suppl):I184-9. DOI: 10.1161/CIRCULATIONAHA.104.526160. View

Carpino P, Khabbaz K, Bojar R, Rastegar H, Warner K, Murphy R . Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1999; 119(1):69-75. DOI: 10.1016/s0022-5223(00)70219-4. View

Robich M, Araujo E, Feng J, Osipov R, Clements R, Bianchi C . Altered coronary microvascular serotonin receptor expression after coronary artery bypass grafting with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2009; 139(4):1033-40. PMC: 2843817. DOI: 10.1016/j.jtcvs.2009.05.032. View

Smith L, Harrell Jr F, Rankin J, Califf R, Pryor D, Muhlbaier L . Determinants of early versus late cardiac death in patients undergoing coronary artery bypass graft surgery. Circulation. 1991; 84(5 Suppl):III245-53. View

Owais K, Huang T, Mahmood F, Hubbard J, Saraf R, Bardia A . Cardiopulmonary Bypass Decreases Activation of the Signal Transducer and Activator of Transcription 3 (STAT3) Pathway in Diabetic Human Myocardium. Ann Thorac Surg. 2015; 100(5):1636-45. DOI: 10.1016/j.athoracsur.2015.05.013. View

Ramlawi B, Feng J, Mieno S, Szabo C, Zsengeller Z, Clements R . Indices of apoptosis activation after blood cardioplegia and cardiopulmonary bypass. Circulation. 2006; 114(1 Suppl):I257-63. DOI: 10.1161/CIRCULATIONAHA.105.000828. View

Tofukuji M, Stahl G, Metais C, Tomita M, Agah A, Bianchi C . Mesenteric dysfunction after cardiopulmonary bypass: role of complement C5a. Ann Thorac Surg. 2000; 69(3):799-807. DOI: 10.1016/s0003-4975(99)01408-3. View

10.

EDMUNDS Jr L . Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1998; 66(5 Suppl):S12-6; discussion S25-8. DOI: 10.1016/s0003-4975(98)00967-9. View

11.

Fietsam Jr R, Bassett J, Glover J . Complications of coronary artery surgery in diabetic patients. Am Surg. 1991; 57(9):551-7. View

12.

Wong R, Baldwin A, Heimark R . Cadherin-5 redistribution at sites of TNF-alpha and IFN-gamma-induced permeability in mesenteric venules. Am J Physiol. 1999; 276(2):H736-48. DOI: 10.1152/ajpheart.1999.276.2.H736. View

13.

Ferraris V, Ferraris S, Harmon R, Evans B . Risk factors for early hospital readmission after cardiac operations. J Thorac Cardiovasc Surg. 2001; 122(2):278-86. DOI: 10.1067/mtc.2001.114776. View

14.

Calafiore A, Di Mauro M, Di Giammarco G, Contini M, Vitolla G, Iaco A . Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease. J Thorac Cardiovasc Surg. 2003; 125(1):144-54. DOI: 10.1067/mtc.2003.73. View

15.

Murohara T, Horowitz J, Silver M, Tsurumi Y, Chen D, Sullivan A . Vascular endothelial growth factor/vascular permeability factor enhances vascular permeability via nitric oxide and prostacyclin. Circulation. 1998; 97(1):99-107. DOI: 10.1161/01.cir.97.1.99. View

16.

Sellke F, Friedman M, Dai H, Shafique T, Schoen F, Weintraub R . Mechanisms causing coronary microvascular dysfunction following crystalloid cardioplegia and reperfusion. Cardiovasc Res. 1993; 27(11):1925-32. DOI: 10.1093/cvr/27.11.1925. View

17.

Feng J, Liu Y, Khabbaz K, Hagberg R, Robich M, Clements R . Decreased contractile response to endothelin-1 of peripheral microvasculature from diabetic patients. Surgery. 2010; 149(2):247-52. PMC: 3000877. DOI: 10.1016/j.surg.2010.07.003. View

18.

Thourani V, Weintraub W, Stein B, Gebhart S, Craver J, Jones E . Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg. 1999; 67(4):1045-52. DOI: 10.1016/s0003-4975(99)00143-5. View

19.

Khabbaz K, Feng J, Boodhwani M, Clements R, Bianchi C, Sellke F . Nonischemic myocardial acidosis adversely affects microvascular and myocardial function and triggers apoptosis during cardioplegia. J Thorac Cardiovasc Surg. 2008; 135(1):139-46. DOI: 10.1016/j.jtcvs.2007.07.035. View

20.

Verma S, Maitland A, Weisel R, Fedak P, Li S, Mickle D . Increased endothelin-1 production in diabetic patients after cardioplegic arrest and reperfusion impairs coronary vascular reactivity: reversal by means of endothelin antagonism. J Thorac Cardiovasc Surg. 2002; 123(6):1114-9. DOI: 10.1067/mtc.2002.121972. View