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Ann Thorac Surg 1995;60:1735-1740
© 1995 The Society of Thoracic Surgeons

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Articles

Blood cardioplegia increases plasma iron overload and thiol levels during cardiopulmonary bypass

Departments of Cardiothoracic Surgery and Anaesthesia & Intensive CAre, Royal Brompton Hospital, National Heart & Lung Institute, London, United Kingdom

Accepted for publication August 2, 1995.

^* Address reprint requests to Dr Gutteridge, Oxygen Chemistry Laboratory, Unit of Critical Care, Department of Anaesthesia & Intensive Care, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK.

Background.: Cardiopulmonary bypass and cross-clamping of the ascending aorta introduce two well-characterized phases of oxidative stress, namely, the extracorporeal circulation of blood and the reoxygenation of ischemic tissue. A feature of both forms of stress is the release of reactive and damaging oxygen species.

Methods.: Forty-seven patients undergoing aortic valve replacment received either cold crystalloid, cold blood, or warm blood cardioplegia. Plasma thiol levels were measured in all groups before and during bypass. All cardiopulmonary bypass patients had, before going onto bypass, low plasma thiol levels (3.80 ± 0.22 nmol/mg protein) compared with normal healthy controls (5.48 ± 0.14 nmol/mg protein).

Results.: Thiol values remained low throughout bypass in patients receiving cold crystalloid cardioplegia, but rose in patients receiving cold blood cardioplegia, and rose even more in patients receiving warm blood cardioplegia to reach normal plasma values. During cardiopulmonary bypass it has previously been reported that plasma transferrin can become fully saturated with iron and cause transient iron overload. Two patients (13%) receiving cold crystalloid cardioplegia went into plasma iron overload, whereas 18% receiving cold blood and 27% receiving warm blood cardioplegia showed plasma iron overload.

Conclusions.: We suggest that blood cardoplegia provides an additional source of thiols as well as a source of reactive iron. However, the reactive iron and thiol-containing molecules have the potential to interact and exacerbate oxidative stress, already a feature of bypass. Control of reactive iron by chelation may be strongly indicated when blood cardioplegia is used.

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