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Moderate hypothermia during cardiopulmonary bypass reduces myocardial cell damage and myocardial cell death related to cardiac surgery

Jaime F. Vazquez-Jimenez, MD^*, Ma Qing, MD, Benita Hermanns, MD, Bernd Klosterhalfen, MD, Michael Wöltje, PhD, Raj Chakupurakal, MD, Kathrin Schumacher, MD, Bruno J. Messmer, MD^*, G.ötz von Bernuth, MD and Marie-Christine Seghaye, MD

^* Departments of Thoracic and Cardiovascular Surgery, Aachen, Germany
Pediatric Cardiology, Aachen, Germany
Institute of Pathology, Aachen, Germany
Interdisciplinary Center for Clinical Research "BIOMAT," Aachen University of Technology, Aachen, Germany

View larger version (15K): [in a new window]   Figure 1 Flow rate of cardiac lymph before, during and after CPB in pigs that were in moderate hypothermia during surgery (temperature [T°]: 28°C) (solid circle) or in normothermia during surgery (T°: 37°C) (solid square). *p < 0.05 between groups; p < 0.05 versus lymph flow measured before CPB in all animals. ACC = aortic cross clamping; CPB = cardiopulmonary bypass.

View larger version (91K): [in a new window]   Figure 2 Example of ultrastructural examination showing discrete focal lesions of cell membrane (arrows) and mitochondria (mi) in animals that were in moderate hypothermia during surgery (A) compared with membrane rupture (arrows), mitochondrial swelling with cristae rarefaction and rupture (mi) in animals in normothermia during surgery (B). Both groups show normal contractile apparatus. myo = myofibril.

View larger version (29K): [in a new window]   Figure 3 (A) Gene expression of tumor necrosis factor- (TNF) and interleukin-10 (IL10) detected in the myocardium taken 6 h after cardiopulmonary bypass (CPB) by reverse transcript polymerase chain reaction in pigs that were in moderate hypothermia during surgery (temperature [T°]: 28°C) (solid bar) and in normothermia during surgery (T°: 37°C) (open bar). Results are expressed as the ratio of cytokines messenger RNA (mRNA)/ß-actin mRNA and are shown as mean ± SEM. *p < 0.0001 and p < 0.1 between groups, respectively. (B) Exemplary gel representative for six independent experiments in each group (moderate hypothermia: T°, 28°C and normothermia: T°, 37°C) showing the effect of core T° during CPB on TNF and IL10 gene expression. Lower panel shows corresponding 18S and 28S ribosomal RNA bands as loading control. C = control sample before CPB; M = molecular-weight marker.

View larger version (25K): [in a new window]   Figure 4 (A) Synthesis of tumor necrosis factor- (TNF) and interleukin-10 (IL10) detected in the myocardium 6 h after cardiopulmonary bypass (CPB) by Western blot in pigs that were in moderate hypothermia during surgery (temperature [T°]: 28°C) (solid bar) and in normothermia (T°: 37°C) (open bar). Band intensities for cytokines were normalized for bands of ß-actin. Results are shown as mean ± SEM. *p < 0.05 between groups, respectively. (B) Exemplary gel obtained after Western blot representative for six independent experiments in each group (moderate hypothermia: T°, 28°C and normothermia: T°, 37°C) showing the effect of core T° during CPB on TNF and IL10 synthesis. C = control sample before CPB.