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Thorac Cardiovasc Surg 2021; 69(01): 034-042
DOI: 10.1055/s-0039-1683427
Original Cardiovascular

Postoperative Plasma Mitochondrial DNA and Cytokine Profiles of Elderly Patients Undergoing Minimally Invasive Aortic Valve Replacement

Francisco Estevez-Cid
1   Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
2   Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
,
Maria E. Serrano-Teruel
2   Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
,
Fernando Fernandez-Rodriguez
3   Department of Laboratory Medicine Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
,
Alberto Bouzas-Mosquera
4   Department of Cardiology Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
,
Mercedes Fernandez-Moreno
2   Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
,
Paula Dieguez-Garcia
5   Department of Anesthesiology Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
,
Jose J. Cuenca-Castillo
1   Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
,
Victor Bautista-Hernandez
1   Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
2   Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain
› Author Affiliations Funding The results of this work have been funded by the project number PI 16/02167 integrated in the National Plan for Scientific Research, Development and, Technological Innovation 2013–2016 and funded by the ISCIII—General Subdirection of Assessment and Promotion of the Research—European Regional Development Fund (FEDER) “A way for making Europe.”
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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


Publication History

Received: 12 October 2018

Accepted: 04 February 2019

Article published online:
14 March 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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