Abstract
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.
Keywords
aortic valve - minimally invasive surgery - inflammation - systemic - cardiopulmonary
bypass - CPB
