Download PDF
Thorac Cardiovasc Surg 2003; 51(2): 57-61
DOI: 10.1055/s-2003-38983
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

The Effects of Intracoronary Administration of Vitamin E on Myocardial Ischemia-Reperfusion Injury During Coronary Artery Surgery

S.  Canbaz1 , E.  Duran1 , T.  Ege1 , H.  Sunar1 , M.  Cikirikcioglu1 , M.  Acipayam1
  • 1Trakya University, Medical Faculty, Department of Cardiovascular Surgery, Edirne, Turkey
Further Information

Publication History

Received: October 21, 2002

Publication Date:
05 May 2003 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: Vitamin E has a strong antioxidant capacity, and has been used in several ischemia-reperfusion studies. The aim of this study was to investigate the effects of water-soluble vitamin E (alpha-tocopherol) on myocardial protection during coronary artery surgery. Methods: Water soluble vitamin E (100 mg) in tepid saline (n = 14) or tepid saline alone (n = 16) was administered into the coronary arteries at the end of aortic cross-clamping. Cardiac troponin-I (cTn-I), MB-isoenzyme of creatine kinase (CK-MB), myoglobin, blood gas, and lactate levels in systemic and coronary sinus blood and hemodynamic variables were assessed during and after the operation. Results: Eight hours after reperfusion, cTn-I levels increased to 3.06 ± 1.8 ng/ml and 6.97 ± 3.9 ng/ml in the vitamin E group and control group, respectively (p = 0.01). Coronary sinus lactate concentration was 2.68 ± 0.5 mmol/l in the vitamin E group and 4.01 ± 1.5 mmol/l in the control group 60 minutes after reperfusion (p = 0.027). Conclusions: Administration of vitamin E into the coronary arteries before removal of the aortic cross-clamp can reduce myocardial cell injury and protect the myocardium from ischemia-reperfusion injury.

Key words

Vitamin E - alpha tocopherol - troponin I - lactate - ischemia-reperfusion injury - coronary artery bypass grafting

References

  • 1 Buckberg G D. Myocardial protection during adult cardiac operations. In: Baue AE, Geha AS, Hammond GL, et al, eds Glenn’s Thoracic and Cardiovascular Surgery. London; Prentice-Hall International Inc 1991: 1432-1433
    Google Scholar
  • 2 Romaschin A D, Wilson G J, Thomas U, Feitler D A, Tumiati L, Mickle D A. Subcellular distribution of peroxidized lipids in myocardial reperfusion injury.  Am J Physiol. 1990;  259 (1 Pt-3) 116-123
    PubMedGoogle Scholar
  • 3 Massey K D, Burton K P. Alpha-tocopherol attenuates myocardial membrane-related alterations resulting from ischemia and reperfusion.  Am J Physiol. 1989;  256 (4 Pt-2) 1192-1199
    PubMedGoogle Scholar
  • 4 Yau T M, Weisel R D, Mickle D A. et al . Vitamin E for coronary bypass operations. A prospective, double blind, randomized trial.  J Thorac Cardiovasc Surg. 1994;  108 (2) 302-310
    PubMedGoogle Scholar
  • 5 Campo G M, Squadrito F, Campo S. et al . Beneficial effect of raxofelast, an hydrophilic vitamin E analogue, in the rat heart after ischemia and reperfusion injury.  J Mol Cell Cardiol. 1998;  30 (8) 1493-1503
    CrossrefPubMedGoogle Scholar
  • 6 Guarnieri C, Giordano E, Muscari C, Caldarera C M. Vitamin E can protect myocardium against oxidative damage.  Cardiovasc Res. 1995;  30 (1) 153-155
    CrossrefPubMedGoogle Scholar
  • 7 Mickle D A. Efficacy of water-soluble analogs of vitamin E in the prevention of myocardial ischemia-reperfusion injury.  Toxicol Ind Health. 1993;  9 (1 - 2) 309-322
    PubMedGoogle Scholar
  • 8 Weisel R D, Mickle D A, Finkle C D. et al . Myocardial free-radical injury after cardioplegia.  Circulation. 1989;  80 ([suppl 5 Pt 2] III) 14-18
    PubMedGoogle Scholar
  • 9 Teoh K H, Mickle D A, Weisel R D. et al . Effect of oxygen tension and cardiovascular operations on the myocardial antioxidant-enzyme activates in patients with tetralogy of Fallot and aorto-coronary bypass.  J Thorac Cardiovasc Surg. 1992;  104 (1) 159-164
    PubMedGoogle Scholar
  • 10 Nagel E, Meyer zu Vilsendorf A, Bartels M, Pichlmayr R. Antioxidative vitamins in prevention of ischemia/reperfusion injury.  Int J Vitam Nutr Res. 1997;  67 (5) 298-306
    PubMedGoogle Scholar
  • 11 Westhuyzen J, Cohcrane A D, Tesar P J. et al . Effect of preoperative supplementation with alpha-tocopherol and ascorbic acid on myocardial injury in patients undergoing cardiac operations.  J Thorac Cardiovasc Surg. 1997;  113 (5) 942-948
    PubMedGoogle Scholar
  • 12 Sethi R, Takeda N, Nagano M, Dhalla N S. Beneficial effects of vitamin E treatment in acute myocardial infarction.  J Cardiovasc Pharmacol Ther. 2000;  5 (1) 1-58
    PubMedGoogle Scholar
  • 13 Yang C S, Chen W Y, Tsai P J, Kuo J S. Alpha-tocopherol acetate significantly supressed the increase in heart interstitial 8-hydroxydeoxyguanosine following myocardial ischemia and reperfusion in anesthetized rats.  Clin Chim Acta. 1999;  285 (1 - 2) 163-168
    CrossrefPubMedGoogle Scholar
  • 14 Rabl H, Khoschsorur G, Petek W. Antioxidative vitamin treatment: effect on lipid peroxidation and limb swelling after revascularization operations.  World J Surg. 1995;  19 (5) 738-744
    CrossrefPubMedGoogle Scholar
  • 15 Vermes E, Mesguich M, Houel R. et al . Cardiac troponin I release after open heart surgery: A marker of myocardial protection?.  Ann Thorac Surg. 2000;  70 (6) 2087-2090
    CrossrefPubMedGoogle Scholar
  • 16 McCord J, Nowak R M, McCullough P A. et al . Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I.  Circulation. 2001;  104 (13) 1483-1488
    PubMedGoogle Scholar
  • 17 Fromm R, Meyer D, Zimmerman J. et al . A double-blind, multicentered study comparing the accuracy of diagnostic markers to predict short- and long-term clinical events and their utility in patients presenting with chest pain.  Clin Cardiol. 2001;  24 (7) 516-520
    PubMedGoogle Scholar
  • 18 Raman J S, Bellomo R, Hayhoe M, Tsamitros M, Buxton B F. Metabolic changes and myocardial injury during cardioplegia: A pilot study.  Ann Thorac Surg. 2001;  72 (5) 1566-1571
    CrossrefPubMedGoogle Scholar
  • 19 Peivandi A A, Dahm M, Hake U. et al . Patterns and diagnostic value of cardiac troponin I vs. troponin T and CKMB after OPCAB surgery.  Thorac Cardiovasc Surg. 2001;  49 (3) 137-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Yan Y, Davani S, Chocron S, Kantelip B, Muret P, Kantelip J P. Effects of L-arginine administration before cardioplegic arrest on ischemia-reperfusion injury.  Ann Thorac Surg. 2001;  72 (6) 1985-1990
    CrossrefPubMedGoogle Scholar
  • 21 de Paulis R, Penta De Peppo A, Colagrande L. et al . Troponin I release after CABG surgery using two different strategies of myocardial protection and systemic perfusion.  J Cardiovasc Surg. 2002;  43 (2) 153-159
    PubMedGoogle Scholar
  • 22 Crittenden M D. Intraoperative metabolic monitoring of the heart: I. Clinical assessment of coronary sinus metabolites.  Ann Thorac Surg. 2001;  72 (6) 2220-2226
    CrossrefPubMedGoogle Scholar
  • 23 Kjellman U W, Björk K, Ekroth R. et al . Addition of alpha-ketoglutarate to blood cardioplegia improves cardioprotection.  Ann Thorac Surg. 1997;  63 (6) 1625-1634
    CrossrefPubMedGoogle Scholar
  • 24 Xiao C Y, Hara A, Yuhki K. et al . Roles of prostaglandin I2 and thromboxane A2 in cardiac ischemia-reperfusion injury: a study using mice lacking their respective receptors.  Circulation. 2001;  104 (18) 2210-2215
    PubMedGoogle Scholar

Dr. Suat Canbaz

Trakya University Medical Faculty, Department of Cardiovascular Surgery

TR 22030 Edirne

Turkey

Phone: 90 284 235 76 56 (office) 90 284 235 57 11 (home)

Fax: 90 284 235 06 65

Email: scanbaz2001@yahoo.com

      >