Subscribe to RSS
Postoperative Plasma Mitochondrial DNA and Cytokine Profiles of Elderly Patients Undergoing Minimally Invasive Aortic Valve ReplacementFunding The results of this work have been funded by the project number PI 16/02167 integrated in the National Plan for Scientific Research, Development and, Technological Innovation 2013–2016 and funded by the ISCIII—General Subdirection of Assessment and Promotion of the Research—European Regional Development Fund (FEDER) “A way for making Europe.”
Introduction Mitochondrial DNA (mtDNA) is gaining increasing interest as a marker of cellular damage and could also act as an inflammatory mediator in cardiopulmonary bypass induced postoperative inflammatory response. Although minimally invasive heart valve surgery reportedly reduces inflammation, the mtDNA and cytokine profile in this context remains unclear.
Materials and Methods Here, we report a prospective series of 40 elderly patients with aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR) through upper ministernotomy with either a sutureless (n = 20) or a conventional (n = 20) valve. Primary end points included serial plasma levels of mtDNA (T1: at baseline; T2: 4 hours after surgery; and T3: 24s hour after surgery), cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), and myocardial necrosis biomarkers (MNBs), whereas secondary end points included clinical and echocardiographic data.
Results Significant increases in the postoperative plasma levels (T2) of mtDNA, cytokines, and MNBs were observed in all patients. The postoperative plasma levels of mtDNA, TNF-α, and MNBs showed no significant differences between the treatment groups, although there was a trend toward lower levels in the sutureless group. The decreases in aortic cross-clamp and cardiopulmonary bypass times seen in the sutureless group were associated with significant lower postoperative levels (T2 and T3) of IL-6.
Conclusion AVR through upper ministernotomy was associated with a significant increase in postoperative plasma levels of mtDNA and cytokines. There was no difference in the mtDNA levels between the sutureless and conventional valve groups, suggesting a similar level of inflammation in both groups. However, the shorter operation time observed in the sutureless valve group was associated with significantly lower postoperative levels of IL-6, indicating potential clinical benefits.
Keywordsaortic valve - minimally invasive surgery - inflammation - systemic - cardiopulmonary bypass - CPB
Received: 12 October 2018
Accepted: 04 February 2019
Article published online:
14 March 2019
© 2019. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Nakayama H, Otsu K. Mitochondrial DNA as an inflammatory mediator in cardiovascular diseases. Biochem J 2018; 475 (05) 839-852
- 2 Qin C, Liu R, Gu J. et al. Variation of perioperative plasma mitochondrial DNA correlate with peak inflammatory cytokines caused by cardiac surgery with cardiopulmonary bypass. J Cardiothorac Surg 2015; 10: 85
- 3 Qin C, Gu J, Hu J. et al. Platelets activation is associated with elevated plasma mitochondrial DNA during cardiopulmonary bypass. J Cardiothorac Surg 2016; 11 (01) 90
- 4 Qin C, Gu J, Qian H, Meng W. Analysis of circulatory mitochondrial DNA level after cardiac surgery with cardiopulmonary bypass and potential prognostic implications. Indian Heart J 2016; 68 (03) 389-390
- 5 Paunel-Görgülü A, Wacker M, El Aita M, Hassan S, Schlachtenberger G, Deppe A. et al. cfDNA correlates with endothelial damage after cardiac surgery with prolonged cardiopulmonary bypass and amplifies NETosis in an intracellular TLR9-independent manner. Sci Rep 2017; ;12; 7 (01) 17421
- 6 Sandler N, Kaczmarek E, Itagaki K. et al. Mitochondrial DAMPs are released during cardiopulmonary bypass surgery and are associated with postoperative atrial fibrillation. Heart Lung Circ 2018; 27 (01) 122-129
- 7 Xu F, Liu RQ, Cao R. et al. Perioperative plasma mitochondrial DNA dynamics and correlation with inflammation during infantile cardiopulmonary bypass. Indian Heart J 2017; 69 (06) 797-800
- 8 Paparella D, Rotunno C, Guida P. et al. Minimally invasive heart valve surgery: influence on coagulation and inflammatory response. Interact Cardiovasc Thorac Surg 2017; 25 (02) 225-232
- 9 Santarpino G, Pfeiffer S, Concistrè G, Fischlein T. Perceval S aortic valve implantation in mini-invasive surgery: the simple sutureless solution. Interact Cardiovasc Thorac Surg 2012; 15 (03) 357-360
- 10 Akins CW, Miller DC, Turina MI. et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Eur J Cardiothorac Surg 2008; 33 (04) 523-528
- 11 Ng CS, Wan S. Limiting inflammatory response to cardiopulmonary bypass: pharmaceutical strategies. Curr Opin Pharmacol 2012; 12 (02) 155-159
- 12 An J, Shi F, Liu S, Ma J, Ma Q. Preoperative statins as modifiers of cardiac and inflammatory outcomes following coronary artery bypass graft surgery: a meta-analysis. Interact Cardiovasc Thorac Surg 2017; 25 (06) 958-965
- 13 Boyapati RK, Tamborska A, Dorward DA, Ho GT. Advances in the understanding of mitochondrial DNA as a pathogenic factor in inflammatory diseases. F1000 Res 2017; 6: 169
- 14 Warren OJ, Smith AJ, Alexiou C. et al. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth 2009; 23 (02) 223-231
- 15 Landis RC, Brown JR, Fitzgerald D. et al. Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: a critical review of the evidence base. J Extra Corpor Technol 2014; 46 (03) 197-211
- 16 Landis C. Why the inflammatory response is important to the cardiac surgical patient. J Extra Corpor Technol 2007; 39 (04) 281-284
- 17 Martínez-Comendador JM, Alvarez JR, Mosquera I. et al. Preoperative statin treatment reduces systemic inflammatory response and myocardial damage in cardiac surgery. Eur J Cardiothorac Surg 2009; 36 (06) 998-1005
- 18 Bronicki RA, Hall M. Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment. Pediatr Crit Care Med 2016; 17 (08) (Suppl. 01) S272-S278
- 19 Meco M, Miceli A, Montisci A. et al. Sutureless aortic valve replacement versus transcatheter aortic valve implantation: a meta-analysis of comparative matched studies using propensity score matching. Interact Cardiovasc Thorac Surg 2018; 26 (02) 202-209
- 20 Shehada SE, Öztürk Ö, Wottke M, Lange R. Propensity score analysis of outcomes following minimal access versus conventional aortic valve replacement. Eur J Cardiothorac Surg 2016; 49 (02) 464-469 , discussion 469–470
- 21 Gilmanov D, Bevilacqua S, Murzi M. et al. Minimally invasive and conventional aortic valve replacement: a propensity score analysis. Ann Thorac Surg 2013; 96 (03) 837-843
- 22 Ranucci M, Frigiola A, Menicanti L, Castelvecchio S, de Vincentiis C, Pistuddi V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis 2012; 21 (06) 732-739
- 23 Ensminger S, Fujita B, Bauer T. et al; GARY Executive Board. Rapid deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018; 71 (13) 1417-1428
- 24 Brocca A, Virzì GM, de Cal M, Giavarina D, Carta M, Ronco C. Elevated levels of procalcitonin and interleukin-6 are linked with postoperative complications in cardiac surgery. Scand J Surg 2017; 106 (04) 318-324
- 25 Gueret G, Lion F, Guriec N. et al. Acute renal dysfunction after cardiac surgery with cardiopulmonary bypass is associated with plasmatic IL6 increase. Cytokine 2009; 45 (02) 92-98
- 26 Whitten CW, Hill GE, Ivy R, Greilich PE, Lipton JM. Does the duration of cardiopulmonary bypass or aortic cross-clamp, in the absence of blood and/or blood product administration, influence the IL-6 response to cardiac surgery?. Anesth Analg 1998; 86 (01) 28-33