Banerjee Debolina, Sabe Sharif A, Sodha Neel R, Ehsan Afshin, Cioffi William G, Miner Thomas J, Li Janelle, Abid M Ruhul, Feng Jun, Sellke Frank W
Department of Surgery, Division of Cardiothoracic Surgery, Cardiovascular Research Center, Brown University/Rhode Island Hospital, USA.
Department of Surgery, Division of Cardiothoracic Surgery, Cardiovascular Research Center, Brown University/Rhode Island Hospital, USA.
Am J Surg. 2025 Jan;239:116052. doi: 10.1016/j.amjsurg.2024.116052. Epub 2024 Oct 29.
Emerging data suggest women have worse outcomes than men following cardioplegia and cardiopulmonary bypass (CP/CPB). Altered coronary microvascular function affecting myocardial perfusion may contribute, but human translational studies are lacking.
Viable coronary microvessels (<200 μ m) were dissected from human atrial samples collected before and after CP/CPB from a subset of 108 patients enrolled. Ex vivo contractile responses to vasopressin were assessed using video microscopy. RNA deep-sequencing and immunoblotting were used to quantify gene and protein expression, respectively.
Coronary microvessels exhibited increased vasopressin-induced contractile responses post-CP/CPB in males and females (p < 0.0001). Females exhibited a decrease in microvascular contractile response versus males pre- (p = 0.1) and post-CP/CPB (p = 0.09) which approached significance. Myocardial vasopressin 1a receptor levels were increased in females versus males (p = 0.001). Vasopressin-induced vasoconstriction predicted postoperative cardiac index.
Impaired coronary microvascular contractile responses in females jeopardizing myocardial perfusion may underlie worse outcomes following cardiac surgery.
新出现的数据表明，在心脏停搏和体外循环（CP/CPB）后，女性的预后比男性差。影响心肌灌注的冠状动脉微血管功能改变可能是原因之一，但缺乏人体转化研究。
从108名入组患者的亚组中，在CP/CPB前后采集的人体心房样本中解剖出有活力的冠状动脉微血管（<200μm）。使用视频显微镜评估对血管加压素的离体收缩反应。RNA深度测序和免疫印迹分别用于定量基因和蛋白质表达。
CP/CPB后，男性和女性的冠状动脉微血管对血管加压素诱导的收缩反应均增加（p<0.0001）。与男性相比，女性在CP/CPB前（p = 0.1）和后（p = 0.09）的微血管收缩反应有所降低，接近显著水平。女性心肌血管加压素1a受体水平高于男性（p = 0.001）。血管加压素诱导的血管收缩可预测术后心脏指数。
女性冠状动脉微血管收缩反应受损，危及心肌灌注，可能是心脏手术后预后较差的原因。
