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Revista chilena de cardiología

On-line version ISSN 0718-8560


CASTILLO, Rodrigo et al. A new strategy of non hypoxic pre conditioning attenuating ischemia-reperfusion injury in patients submitted to cardiac surgery with extracorporeal circulation. Rev Chil Cardiol [online]. 2009, vol.28, n.1, pp.31-44. ISSN 0718-8560.

Background: Oxygen reactive species (ORS) might be involved in structural and electrical changes rendering the atria susceptible to arrhythmias and contractile dysfunction. Aim: to determine the effect of supplementation with omega-3 and vitamins C and E on the anti-oxidative capacity of patients submitted to cardiac surgery with extracorporeal circulation (EC). Methods: the study was performed on 50 patients: 15 received omega-3 7 days before and vitamins C and E 2 days before surgery; 15 patients received placebo; 30 patients served as controls and did not received drugs or placebo. Blood samples were obtained before omega-3 administration, again before vitamin administration, 6-8 hr postoperatively and at discharge. Plasma antioxidant capacity (FRAP), the relation of reduced to oxidized glutathione (GSH/GSSG), erythrocyte antioxidant enzymes and oxidative stress (malon-dialdehyde (MDA) and F2 isoprostanes) were measured. Western blott was used to determine the expression of the cathalytic subunit of NADPH oxydase (NOX-2) and its cytosolic fraction (p47phox). Immunofluorescence was used to localize the membrane subunit NOX-2/gp91phox. The levels of MDA were used as an index of oxidative stress. Statistical analysis was performed with ANOVA and one-way post test Bonferroni. Results: treated patients had 56% greater levels of GSH/GSSG at the time of surgery; after the operation their FRAP values were 30% greater and glutathione peroxydase 25% greater than the placebo group. Treated patients also had a decreased expression of NOX-2/gp91phox and p47phox compared to placebo. The presence ofgp91phox in the plasma membrane of cardiomyocytes was confirmed by immunofluorecense. Plasma MDA levels were 21% lower and tissue levels 46% lower in the treated group. Also, F2-isoprostanes were 27% lower in the same group. Conclusion: omega-3 and antioxidant vitamin supplementation decreases the oxidative stress in patients undergoing cardiac surgery with EC. It is postulated that the observed effect might be related to down-regulation of NADPH oxydase in cardiomyocytes.

Keywords : Cardiac surgery; oxidative stress; atrial tissue; NADPH oxidase.

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