Abstract
Background: Vitamin E has a strong antioxidant capacity, and has been used in several ischemia-reperfusion studies. The aim of this study was to investigate the effects of water-soluble vitamin E (alpha-tocopherol) on myocardial protection during coronary artery surgery. Methods: Water soluble vitamin E (100 mg) in tepid saline (n = 14) or tepid saline alone (n = 16) was administered into the coronary arteries at the end of aortic cross-clamping. Cardiac troponin-I (cTn-I), MB-isoenzyme of creatine kinase (CK-MB), myoglobin, blood gas, and lactate levels in systemic and coronary sinus blood and hemodynamic variables were assessed during and after the operation. Results: Eight hours after reperfusion, cTn-I levels increased to 3.06 ± 1.8 ng/ml and 6.97 ± 3.9 ng/ml in the vitamin E group and control group, respectively (p = 0.01). Coronary sinus lactate concentration was 2.68 ± 0.5 mmol/l in the vitamin E group and 4.01 ± 1.5 mmol/l in the control group 60 minutes after reperfusion (p = 0.027). Conclusions: Administration of vitamin E into the coronary arteries before removal of the aortic cross-clamp can reduce myocardial cell injury and protect the myocardium from ischemia-reperfusion injury.
Key words
Vitamin E - alpha tocopherol - troponin I - lactate - ischemia-reperfusion injury - coronary artery bypass grafting
References
-
1 Buckberg G D. Myocardial protection during adult cardiac operations. In: Baue AE, Geha AS, Hammond GL, et al, eds Glenn’s Thoracic and Cardiovascular Surgery. London; Prentice-Hall International Inc 1991: 1432-1433
-
2
Romaschin A D, Wilson G J, Thomas U, Feitler D A, Tumiati L, Mickle D A.
Subcellular distribution of peroxidized lipids in myocardial reperfusion injury.
Am J Physiol.
1990;
259
(1 Pt-3)
116-123
-
3
Massey K D, Burton K P.
Alpha-tocopherol attenuates myocardial membrane-related alterations resulting from ischemia and reperfusion.
Am J Physiol.
1989;
256
(4 Pt-2)
1192-1199
-
4
Yau T M, Weisel R D, Mickle D A. et al .
Vitamin E for coronary bypass operations. A prospective, double blind, randomized trial.
J Thorac Cardiovasc Surg.
1994;
108
(2)
302-310
-
5
Campo G M, Squadrito F, Campo S. et al .
Beneficial effect of raxofelast, an hydrophilic vitamin E analogue, in the rat heart after ischemia and reperfusion injury.
J Mol Cell Cardiol.
1998;
30
(8)
1493-1503
-
6
Guarnieri C, Giordano E, Muscari C, Caldarera C M.
Vitamin E can protect myocardium against oxidative damage.
Cardiovasc Res.
1995;
30
(1)
153-155
-
7
Mickle D A.
Efficacy of water-soluble analogs of vitamin E in the prevention of myocardial ischemia-reperfusion injury.
Toxicol Ind Health.
1993;
9
(1 - 2)
309-322
-
8
Weisel R D, Mickle D A, Finkle C D. et al .
Myocardial free-radical injury after cardioplegia.
Circulation.
1989;
80
([suppl 5 Pt 2] III)
14-18
-
9
Teoh K H, Mickle D A, Weisel R D. et al .
Effect of oxygen tension and cardiovascular operations on the myocardial antioxidant-enzyme activates in patients with tetralogy of Fallot and aorto-coronary bypass.
J Thorac Cardiovasc Surg.
1992;
104
(1)
159-164
-
10
Nagel E, Meyer zu Vilsendorf A, Bartels M, Pichlmayr R.
Antioxidative vitamins in prevention of ischemia/reperfusion injury.
Int J Vitam Nutr Res.
1997;
67
(5)
298-306
-
11
Westhuyzen J, Cohcrane A D, Tesar P J. et al .
Effect of preoperative supplementation with alpha-tocopherol and ascorbic acid on myocardial injury in patients undergoing cardiac operations.
J Thorac Cardiovasc Surg.
1997;
113
(5)
942-948
-
12
Sethi R, Takeda N, Nagano M, Dhalla N S.
Beneficial effects of vitamin E treatment in acute myocardial infarction.
J Cardiovasc Pharmacol Ther.
2000;
5
(1)
1-58
-
13
Yang C S, Chen W Y, Tsai P J, Kuo J S.
Alpha-tocopherol acetate significantly supressed the increase in heart interstitial 8-hydroxydeoxyguanosine following myocardial ischemia and reperfusion in anesthetized rats.
Clin Chim Acta.
1999;
285
(1 - 2)
163-168
-
14
Rabl H, Khoschsorur G, Petek W.
Antioxidative vitamin treatment: effect on lipid peroxidation and limb swelling after revascularization operations.
World J Surg.
1995;
19
(5)
738-744
-
15
Vermes E, Mesguich M, Houel R. et al .
Cardiac troponin I release after open heart surgery: A marker of myocardial protection?.
Ann Thorac Surg.
2000;
70
(6)
2087-2090
-
16
McCord J, Nowak R M, McCullough P A. et al .
Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I.
Circulation.
2001;
104
(13)
1483-1488
-
17
Fromm R, Meyer D, Zimmerman J. et al .
A double-blind, multicentered study comparing the accuracy of diagnostic markers to predict short- and long-term clinical events and their utility in patients presenting with chest pain.
Clin Cardiol.
2001;
24
(7)
516-520
-
18
Raman J S, Bellomo R, Hayhoe M, Tsamitros M, Buxton B F.
Metabolic changes and myocardial injury during cardioplegia: A pilot study.
Ann Thorac Surg.
2001;
72
(5)
1566-1571
-
19
Peivandi A A, Dahm M, Hake U. et al .
Patterns and diagnostic value of cardiac troponin I vs. troponin T and CKMB after OPCAB surgery.
Thorac Cardiovasc Surg.
2001;
49
(3)
137-143
-
20
Yan Y, Davani S, Chocron S, Kantelip B, Muret P, Kantelip J P.
Effects of L-arginine administration before cardioplegic arrest on ischemia-reperfusion injury.
Ann Thorac Surg.
2001;
72
(6)
1985-1990
-
21
de Paulis R, Penta De Peppo A, Colagrande L. et al .
Troponin I release after CABG surgery using two different strategies of myocardial protection and systemic perfusion.
J Cardiovasc Surg.
2002;
43
(2)
153-159
-
22
Crittenden M D.
Intraoperative metabolic monitoring of the heart: I. Clinical assessment of coronary sinus metabolites.
Ann Thorac Surg.
2001;
72
(6)
2220-2226
-
23
Kjellman U W, Björk K, Ekroth R. et al .
Addition of alpha-ketoglutarate to blood cardioplegia improves cardioprotection.
Ann Thorac Surg.
1997;
63
(6)
1625-1634
-
24
Xiao C Y, Hara A, Yuhki K. et al .
Roles of prostaglandin I2 and thromboxane A2 in cardiac ischemia-reperfusion injury: a study using mice lacking their respective receptors.
Circulation.
2001;
104
(18)
2210-2215
Dr. Suat Canbaz
Trakya University Medical Faculty, Department of Cardiovascular Surgery
TR 22030 Edirne
Turkey
Telefon: 90 284 235 76 56 (office) 90 284 235 57 11 (home)
Fax: 90 284 235 06 65
eMail: scanbaz2001@yahoo.com
