EXPRESSION OF APOPTOTIC REACTIONS IN PATIENTS WITH CORONARY HEART DISEASE DURING CORONARY ARTERY BYPASS GRAFTING WITH CARDIOPULMONARY BYPASS DEPENDING ON THE ANESTHETIC SCHEME
DOI:
https://doi.org/10.11603/2415-8798.2019.1.9959Keywords:
coronary artery bypass grafting, cardiopulmonary bypass, ischemic heart disease, apoptosisAbstract
According to research data, the mortality rate among elderly and senile patients after coronary artery bypass surgery is from 3 to 11 %, along with how complications occur in 30–40 % of cases. One of the most frequent disorders that can be observed in the early postoperative period and which directly threaten the lives of patients is postoperative cardiac dysfunction. An important role in its pathogenesis is played by the growth of the death of cardiomyocytes during apoptosis.
The aim of the study – to learn the severity of the effect on the apoptotic reactions of various anesthetic management schemes in patients with coronary heart disease during coronary artery bypass grafting with cardiopulmonary bypass.
Materials and Methods. The study included 20 patients with coronary heart disease who underwent coronary artery bypass grafting (CABG-3) with cardiopulmonary bypass. The average age was (68.5±4.1) years. The share of men – 70.0 %, women – 30.0 %. Depending on the scheme of anesthetic management, all patients were divided into 2 groups: group 1 (10 people) – using sevoflurane; group 2 (10 people) – using propofol. Local protection of the myocardium – artificial electrical fibrillation. Myocardial biopsy specimens were collected from the right atrial appendage. Histological sections were used to conduct immunohistochemical studies using primary antibodies against BAX protein, Bcl2 protein and caspase 3 (DAKO).
Results and Discussion. Under the anesthetic scheme using sevofluran as hypnotics, the expression of the anti-apoptic Bcl 2 gene was 5 times higher (p = 0.003) compared with similar values obtained in patients using propofol. The expression of pro-apoptic genes cpp 32 and BAX in the group with anesthesia of sevoflurane was in 3 (p = 0.032) and 2 times (p = 0.011), respectively, significantly less, compared with group using propofol.
Conclusions. By increasing the expression of the anti-apoptic Bcl 2 gene and reducing the expression of the pro-apoptic genes Cpp 32 and BAX, sevoflurane is significantly less compared with propofol affects the activation of apoptosis, resulting in a reduced probability of programmed cell death of myocardiocytes.
References
Manji, R.A., Arora, R.C., Singal, R.K., Hiebert, B., Moon, M.C., Freed, D.H., & Menkis, A.H. (2016). Long-term outcome and predictors of noninstitutionalized survival subsequent to prolonged intensive care unit stay after cardiac surgical procedures. Ann Thorac Surg, 101, 56-63.
Lomivorotov, V.V., Efremov, S.M., Kirov, M.Y., Fominskiy, E.V., & Karaskov, A.M. (2017). Low-cardiac-output syndrome after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 31, 291-308.
Czabotar, P.E., Lessene, G., Strasser, A., & Adams, J.M. (2014). Control of apoptosis by the BCL-2 protein family: implications for physiology and therapy. Nat Rev Mol Cell Biol, 15, 49-63.
Ha, J.H., Shin, J.S., Yoon, M.K., Lee, M.S., He, F., Bae, K.H., … & Chi, S.W. (2013). Dual-site interactions of p53 protein transactivation domain with anti-apoptotic Bcl-2 family proteins reveal a highly convergent mechanism of divergent p53 pathways. J Biol Chem, 288, 7387-7398.
Goldar, S., Khaniani, M.S., Derakhshan, S.M., & Baradarn, B. (2015). Molecular mechanisms of apoptosis and roles in cancer development and treatment. Asian Pac. J. Cancer Prev, 16, 2129-2144.
Downloads
Published
How to Cite
Issue
Section
License
Authors who sent their manuscript to "Вісник наукових досліджень. Bulletin of Scientific Research" Surgery agree to the following terms:
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal. 
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
