Department of Cardiac Surgery, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain.
Department of Experimental Cardiovascular Surgery, Institute of Biomedical Research of A Coruna, A Coruna, Spain.
Thorac Cardiovasc Surg. 2021 Jan;69(1):34-42. doi: 10.1055/s-0039-1683427. Epub 2019 Mar 14.
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.
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 ( = 20) or a conventional ( = 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.
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.
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.
线粒体 DNA（mtDNA）作为细胞损伤的标志物越来越受到关注，并且在体外循环诱导的术后炎症反应中也可能充当炎症介质。尽管微创心脏瓣膜手术据称可减轻炎症，但在此背景下，mtDNA 和细胞因子谱仍不清楚。
在这里，我们报告了一项前瞻性系列研究，共纳入 40 例接受经胸骨上段小切口生物瓣主动脉瓣置换术（AVR）的老年主动脉瓣狭窄患者，其中 20 例行无缝线（ = 20）或传统（ = 20）瓣膜置换。主要终点包括 mtDNA（T1：基线时；T2：手术后 4 小时；T3：手术后 24 小时）、细胞因子（白细胞介素 6 [IL-6]、肿瘤坏死因子-α [TNF-α]）和心肌坏死生物标志物（MNB）的连续血浆水平，而次要终点包括临床和超声心动图数据。
所有患者术后 mtDNA、细胞因子和 MNB 的血浆水平均显著升高。尽管无缝线组的水平较低，但两组间 mtDNA、TNF-α 和 MNB 的术后血浆水平无显著差异。无缝线组主动脉阻断和体外循环时间的缩短与术后 IL-6 的水平显著降低有关。
经胸骨上段小切口的 AVR 会导致术后 mtDNA 和细胞因子的血浆水平显著升高。无缝线瓣膜组和传统瓣膜组的 mtDNA 水平无差异，表明两组的炎症程度相似。然而，无缝线瓣膜组手术时间较短与术后 IL-6 水平显著降低有关，提示其具有潜在的临床获益。
