Zajonz Thomas, Koch Christian, Schwiddessen Jan, Markmann Melanie, Hecker Matthias, Edinger Fabian, Schmidt Götz, Boening Andreas, Sander Michael, Schneck Emmanuel
Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, 35392 Giessen, Germany.
German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35392 Giessen, Germany.
J Clin Med. 2022 May 25;11(11):2994. doi: 10.3390/jcm11112994.
The use of minimized extracorporeal circulation (MiECC) during cardiac surgery is associated with a reduced inflammatory reaction compared to conventional cardiopulmonary bypass (cCPB). Since it is unknown if MiECC also reduces the amount of free-circulating mitochondrial DNA (mtDNA), this study aims to compare MiECC-induced mtDNA release to that of cCPB as well as to identify potential relations between the plasma levels of mtDNA and an adverse outcome. Overall, 45 patients undergoing cardiac surgery with either cCPB or MiECC were included in the study. MtDNA encoding for NADH dehydrogenase 1 was quantified with quantitative polymerase chain reaction. The plasma amount of mtDNA was significantly lower in patients undergoing cardiac surgery with MiECC compared to cCPB (MiECC: 161.8 (65.5−501.9); cCPB 190.8 (82−705.7); p < 0.001). Plasma levels of mtDNA showed comparable kinetics independently of the study group and peaked during CPB (MiECC preoperative: 68.2 (26.5−104.9); MiECC 60 min after start of CPB: 536.5 (215.7−919.6); cCPB preoperative: 152.5 (80.9−207.6); cCPB 60 min after start of CPB: 1818.0 (844.2−3932.2); all p < 0.001). Patients offering an mtDNA blood concentration of >650 copies/µL after the commencement of CPB had a 5-fold higher risk for postoperative atrial fibrillation independently of the type of cardiopulmonary bypass. An amount of mtDNA being higher than 650 copies/µL showed moderate predictive power (AUROC 0.71 (0.53−071)) for the identification of postoperative atrial fibrillation. In conclusion, plasma levels of mtDNA were lower in patients undergoing cardiac surgery with MiECC compared to cCPB. The amount of mtDNA at the beginning of the CPB was associated with postoperative atrial fibrillation independent of the type of cardiopulmonary bypass.
与传统体外循环（cCPB）相比，心脏手术中使用微创体外循环（MiECC）与炎症反应减轻有关。由于尚不清楚MiECC是否也能减少游离循环线粒体DNA（mtDNA）的量，本研究旨在比较MiECC诱导的mtDNA释放与cCPB诱导的mtDNA释放，并确定mtDNA血浆水平与不良结局之间的潜在关系。本研究共纳入45例接受cCPB或MiECC心脏手术的患者。采用定量聚合酶链反应对编码NADH脱氢酶1的mtDNA进行定量。与cCPB相比，接受MiECC心脏手术的患者血浆mtDNA量显著降低（MiECC：161.8（65.5−501.9）；cCPB：190.8（82−705.7）；p<0.001）。mtDNA血浆水平显示出相似的动力学，与研究组无关，且在体外循环期间达到峰值（MiECC术前：68.2（26.5−104.9）；MiECC体外循环开始后60分钟：536.5（215.7−919.6）；cCPB术前：152.5（80.9−207.6）；cCPB体外循环开始后60分钟：1818.0（844.2−3932.2）；所有p<0.001）。体外循环开始后mtDNA血液浓度>650拷贝/µL的患者，无论体外循环类型如何，术后房颤风险高出5倍。mtDNA量高于650拷贝/µL对术后房颤的识别具有中等预测能力（曲线下面积0.71（0.53−0.71））。总之，与cCPB相比，接受MiECC心脏手术的患者血浆mtDNA水平较低。体外循环开始时的mtDNA量与术后房颤相关，与体外循环类型无关。
