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Ann Thorac Surg 1999;67:112-119
© 1999 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Department of Surgery, Brigham and Womens Hospital and Harvard Medical School, Boston, Massachusetts, USA
b Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Brigham and Womens Hospital and Harvard Medical School, Boston, Massachusetts, USA
c Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesia, Brigham and Womens Hospital and Harvard Medical School, Boston, Massachusetts, USA
Accepted for publication June 23, 1998.
Address reprint requests to Dr Sellke, Division of Cardiothoracic Surgery, Beth Israel-Deaconess Medical Center, East Campus, 330 Brookline Ave, Boston, MA 02215
Background. Although administration of the sialyl Lewisx oligosaccharide may reduce myocardial injury after ischemiareperfusion, its effect on coronary and cerebral microvascular regulation and its clinical application during cardiac operation have not been examined.
Methods. Pigs were placed on normothermic cardiopulmonary bypass after 30 minutes of left anterior descending coronary artery occlusion. The hearts were then arrested with cold high potassium cardioplegia. After 1 hour the cross-clamp was removed and the pigs were weaned from cardiopulmonary bypass and perfused for an additional 1 hour. CY-1503 (a sodium salt of the sialyl LewisX oligosaccharide, n = 6) was administered before reperfusion. Six other pigs received saline vehicle. Endothelium-dependent relaxation of precontracted coronary and brain arterioles (70 to 180 µm) to adenosine 5'-diphosphate and endothelium-independent relaxation to sodium nitroprusside were studied in vitro with videomicroscopy. Control values were obtained from uninstrumented pigs. Myeloperoxidase activity in the myocardium and brain was measured to quantify neutrophil infiltration. Cardiac function and perfusion were assessed by left ventricular systolic pressure, maximum rate of increase of left ventricular pressure, left anterior descending coronary artery blood flow and percent segmental shortening, and cerebral vascular resistance, internal carotid artery blood flow, and the constitutively expressed and inducible isoform of nitric oxide synthase mRNA were measured.
Results. The impaired myocardial contractile function after ischemia and cardioplegia was not improved by administration of CY-1503. The reduced endothelium-dependent relaxation responses of coronary and brain arterioles during ischemia followed by cardioplegia and cardiopulmonary bypass were improved with CY-1503, but the altered pattern of organ perfusion was not improved. Myeloperoxidase activity was increased in the heart after ischemiacardioplegia and in the brain after cardiopulmonary bypass. CY-1503 reduced myeloperoxidase activity in both the myocardium and in the brain. Expressions of myocardial inducible isoform or constitutively expressed nitric oxide synthase were not altered in the heart.
Conclusions. Although the sialyl Lewisx oligosaccharide does reduce neutrophil infiltration and endothelial injury in the coronary and cerebral microcirculation after cardiopulmonary bypass, it does not have significant beneficial acute effects on organ perfusion or function in the myocardium or brain.
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