Normoxic cardiopulmonary bypass reduces oxidative myocardial damage and nitric oxide during cardiac operations in the adult

Postischemic reperfusion injury can be attenuated by oxygen tension control

Oxygen-derived free radicals cause cytotoxic damage during reperfusion after a period of ischemia and the production of these free radicals may be proportionate to oxygen tension (PO2). The present study tested the hypothesis that oxidative damage may be limited by maintaining a more physiologic PO2 following ischemia. An experimental study in Wistar rats were mounted on a Langendorff apparatus was conducted to estimate baseline aortic flow (AF), coronary flow (CF), cardiac output (CO), systolic pressure (SP), heart rate (HR), and the rate-pressure product (RPP: HRxSP). The hearts were divided into 3 groups (n=7, hearts/group): group 1, hypoxic (PO2=300+/-50 mmHg) reperfusion; group 2, middleoxic (PO2=500+/-50 mmHg) reperfusion; and group 3, hyperoxic (PO2=700+/-50 mmHg) reperfusion. Following 30 min of warm ischemia, hearts in all groups were reperfused at each oxygen pressure. The recovery of cardiac function of each heart was measured at the end of reperfusion. Concentrations of lactate (LAC), lactate dehydrogenase (LDH), and creatine kinase (CK) in the coronary perfusate during reperfusion were measured. The recovery rate of CO, SP, and RPP in group 2 were all significantly better than in the other 2 groups. CK leakage in group 2 was significantly lower than in group 3. A clinical study was also conducted during elective coronary artery bypass grafts in 16 consecutive patients who underwent either hyperoxic (n=8, PO2=450-550 mmHg) or more physiologic (n=8, PO2=200-250 mmHg) cardiopulmonary bypass after aortic unclamping. The clinical study assessed CK-MB, LDH, LAC, and malondialdehyde (MDA) in patient blood prior to starting the surgical procedure and at 30 min and 3, 9, and 21 h after unclamping. Cardiac index (CI), central venous pressure, pulmonary capillary wedge pressure, systolic arterial pressure, and the dose of cathecholamines were also measured. Although no significant differences were present in the dose of cathecholamines, the CI in the more physiologic oxygen tension group was significantly higher than in the hyperoxic group at 3 and 6 h after unclamping. The levels of MDA in the more physiologic PO2 group was significantly lower at 30 min after aortic unclamping than in the hyperoxic group. The present results suggest that in the experimental as well as in the clinical study, high PO2 leads to myocardial reperfusion damage; however, maintaining a more physiologic PO2 during reperfusion following ischemia may attenuate reperfusion injury.