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Ann Thorac Surg 2003;76:528-534
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Cardiomyocyte apoptosis and ischemic preconditioning in open heart operations

Zhong-Kai Wu, MD, PhDa,b, Jari Laurikka, MD, PhDa, Antti Saraste, MD, PhDc, Ville Kytö, MBc, Erkki J. Pehkonen, MD, PhDa, Timo Savunen, MD, PhDb, Matti R. Tarkka, MD, PhDa*

a Division of Cardiac Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland
b Department of Cardiac Surgery, Affiliated 1st Hospital, Sun Yat-sen University, GuangZhou, China
c Department of Cardiac Surgery, Turku University Hospital, Turku, Finland

Accepted for publication February 21, 2003.

* Address reprint requests to Dr Tarkka, Clinic of Cardiac Surgery, Tampere University Hospital, 33521 Tampere, Finland
e-mail: matti.tarkka{at}tays.fi

BACKGROUND: The aim of the present study was to ascertain the percentage of left apical myocardial apoptosis in three-vessel coronary artery bypass grafting patients quantitatively and the impact of ischemic preconditioning.

METHODS: Twenty-one patients with three-vessel disease who had elective coronary artery bypass grafting were randomized in a ratio of 2:1 to ischemic preconditioning (n = 14) or a control group (n = 7). The ischemic preconditioning protocol was established by two cycles of ascending aorta occlusion for 2 minutes followed by 3 minutes of reperfusion. Myocardial samples from the apex of the left ventricle were taken using a Tru-Cut needle before aortic cross-clamping and immediately after declamping. The percentage of apoptosis was analyzed by TUNEL methods. Data on hemodynamics and biochemical markers were collected.

RESULTS: Low levels of myocardial apoptosis were found before the operation (0.01% ± 0.00%). During the early reperfusion period, the percentage of myocardial apoptotic cells significantly increased (0.15% ± 0.05%, p = 0.008). Ischemic preconditioning significantly improved cardiac index and right ventricular ejection fraction recovery after the operation (p = 0.036 and 0.001 respectively, repeated measure) but had no effect on myocardial apoptosis before and after the operation (0.01 ± 0.00 versus 0.01 ± 0.00, p = 0.658 and 0.12% ± 0.04% versus 0.23% ± 0.14%, p = 0.302).

CONCLUSIONS: Cardioplegic myocardial ischemia during open heart operation was associated with induction of cardiomyocyte apoptosis in humans. Attenuation of postoperative cardiac dysfunction by ischemic preconditioning appeared to be independent of apoptosis.




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