Research Information System
JOURNAL OF CARDIOTHORACIC SURGERY, vol.21, no.1, 2025 (SCI-Expanded, Scopus)
Purpose Cardioplegia is routinely used in cardiac surgery to prevent endothelial damage associated with ischemia-reperfusion. However, there is no consensus on the optimal vasculoprotective cardioplegia. We aim to assess endothelial integrity using coronary sinus blood samples in patients who have received various types of cardioplegia. Methods Aortic valve replacement for aortic stenosis and isolated coronary artery bypass grafting patients were included. del Nido and blood cardioplegias were subjected to assessment. Blood samples from the coronary sinus were collected before and after aortic cross-clamping. Endothelial and redox biomarkers were assessed utilizing immunochemical and colorimetric techniques. Results In coronary artery bypass grafting patients, E-selectin levels were found significantly lower after cross-clamping compared to pre-clamp values, regardless of cardioplegia type (p = 0.015). ROC analysis revealed that Endocan, E-selectin, and TNF-alpha levels are reliable biomarkers of endothelial injury after cardiopulmonary bypass (p values: 0.004, 0.007, and < 0.001 for each parameter, respectively). Total oxidant status emerged as a significant redox biomarker, with 87% ROC sensitivity (p = 0.037). Conclusion This study uniquely assesses localized endothelial responses via coronary sinus sampling with a multiplex biomarker panel, providing evidence of del Nido cardioplegia's protection. Our findings indicate that del Nido cardioplegia exhibits significant vasculoprotection, as evidenced by modulation of coronary sinus Endocan, E-selectin, and TNF-alpha. These biomarker changes, together with the absence of adverse differences in major postoperative outcomes, suggest that del Nido cardioplegia provides efficient myocardial and vascular protection in both aortic valve replacement and coronary artery bypass procedures, supporting its safe use in adult elective cardiac surgery.