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Review
. 2016:2016:1971452.
doi: 10.1155/2016/1971452. Epub 2016 Mar 31.

Oxidative Stress after Surgery on the Immature Heart

Daniel Fudulu  1 , Gianni Angelini  1
Affiliations
Review

Oxidative Stress after Surgery on the Immature Heart

Daniel Fudulu et al. Oxid Med Cell Longev. 2016.

Abstract

Paediatric heart surgery is associated with increased inflammation and the production of reactive oxygen species. Use of the extracorporeal cardiopulmonary bypass during correction of congenital heart defects generates reactive oxygen species by various mechanisms: haemolysis, neutrophil activation, ischaemia reperfusion injury, reoxygenation injury, or depletion of the endogenous antioxidants. The immature myocardium is more vulnerable to reactive oxygen species because of developmental differences compared to the adult heart but also because of associated congenital heart diseases that can deplete its antioxidant reserve. Oxidative stress can be manipulated by various interventions: exogenous antioxidants, use of steroids, cardioplegia, blood prime strategies, or miniaturisation of the cardiopulmonary bypass circuit. However, it is unclear if modulation of the redox pathways can alter clinical outcomes. Further studies powered to look at clinical outcomes are needed to define the role of oxidative stress in paediatric patients.

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Figures

Figure 1
Figure 1
The various reactive oxygen species (ROS) injure cells by three main mechanisms: lipid peroxidation, protein oxidative damage, and DNA damage. Cellular injury is limited by the action of the main antioxidant enzymes (scavengers). There is a complex cross talk between ROS and NF-κB transcription factors that regulate the production of antioxidants.
Figure 2
Figure 2
The various mechanisms of production of ROS with use of extracorporeal circuit. The immature myocardium is vulnerable to ROS injury because of age specific differences compared to the adult heart but also because of coexistent congenital heart disease. The end-result is contractile dysfunction.
Figure 3
Figure 3
Interventions to reduce oxidative stress in paediatric heart surgery.
See this image and copyright information in PMC

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