Coronary endothelial injury after cardiopulmonary bypass and ischemic cardioplegia is mediated by oxygen-derived free radicals.

Abstract

Cardiopulmonary bypass and crystalloid cardioplegia may lead to endothelial dysfunction in the coronary microcirculation. The aim of the present study was to examine whether the alteration of endothelium-dependent microvascular responses may be related to the generation of oxygen-derived free radicals. Pigs (30 kg) were heparinized and placed on cardiopulmonary bypass. The hearts were arrested for 1 hour with either plain hypothermic, hyperkalemic (25 mEq/L) crystalloid cardioplegic solution (n = 10) or crystalloid cardioplegic solution containing either deferoxamine (n = 8) or manganese superoxide dismutase (n = 6). Hearts were then reperfused for 1 hour while the pigs were separated from cardiopulmonary bypass. Noninstrumented pigs were used as controls (n = 8). Coronary microarteries (120 to 190 microns in diameter) were studied in vitro in a pressurized (40 mm Hg), no-flow state with videomicroscopy and electronic dimension analysis. After precontraction of microvessels, the endothelium-dependent and -independent agents were applied extraluminally. Serotonin caused a slight dilation of control vessels (percent dilation of acetylcholine-induced preconstriction at 10 mumol/L drug concentration, 5 +/- 8%; P < .05 versus crystalloid cardioplegia group) and a significant contractile response after crystalloid cardioplegia (-28 +/- 10%). Bradykinin elicited near complete relaxation of control vessels (96 +/- 3%, P < .05), whereas it caused considerably less relaxation after cardioplegia (33 +/- 9%). The addition of either deferoxamine or superoxide dismutase to the cardioplegic solution significantly (but not completely) preserved vasomotor responses of coronary microvessels to serotonin (9 +/- 6% and 11 +/- 4%, respectively; P < .05) or bradykinin (72 +/- 4% and 87 +/- 3%, respectively; P < .05). Endothelium-independent relaxations of vessels in response to sodium nitroprusside were similar in all groups. Either the hydroxyl radical synthesis inhibitor deferoxamine or manganese superoxide dismutase preserves endothelium-dependent relaxation during crystalloid cardioplegia-reperfusion. Therefore, ischemic cardioplegia-reperfusion-induced endothelial dysfunction is at least partially mediated by the generation of oxygen-derived free radicals.