Kardioprotekcja – analiza publikacji dotyczących protekcji mięśnia sercowego

• Authors: Bartosz Andrzej Kuźlik , Małgorzata Gawlak , Marta Mazur , Katarzyna Ciesielska , Piotr Buszman , Krzysztof Sanetra

Title variants

EN

Cardioprotection: an analysis of publications on myocardial protection

Abstracts

EN

The pathophysiology of a reperfusion injury, which poses a challenge after a cardiac ischemic episode, is not fully understood. Several molecular processes show possible ways to counteract this phenomenon. One is to prepare the heart for the onset of an ischemic episode, which can be achieved by physical training of the patient or pharmacotherapy. Another approach is to act pharmacologically on the miRNA or NRF2 family of transcription factors. Crucial for cardiac surgery is the use of an appropriate cardioplegin solution and to administer it correctly. Recent studies have focused particularly on the use of del Nido cardioplegin, which, when administered, allows for the extension of safe myocardial ischemia for up to 120 minutes in higher-risk patients. The use of trimetazidine makes it possible to reduce cardiovascular risk in older patients after surgery, and the administration of Alfacalcidol before valve surgery reduces the risk of perioperative complications. By inducing pathological conditions in animals, it is possible to test compounds that can counteract these phenomena or reduce their severity. Compounds such as disulfiram, crocin, stachytin, gosypine, or metformin in combination with hydrogen can reduce the risk of cardiovascular complications and cardiac remodelling. Cardioprotection is important in the pediatric population because of the effects of some therapies that cause iatrogenic myocardial damage. Administration of dexrazoxane or glutathione in combination with doxarubicin therapy can reduce myocardial damage in the pediatric population without reducing the efficacy of the chemotherapeutics. The cardioprotective effects of carvedilol, captopril, simvastatin and L-carnitine, as well as some supplements, have also been demonstrated.

PL

Patofizjologia uszkodzenia reperfuzyjnego, będącego wyzwaniem po epizodzie niedokrwiennym serca, nie została do końca poznana. Kilka procesów molekularnych wykazuje ewentualne możliwości przeciwdziałania temu zjawisku. Jeden z nich polega na przygotowaniu serca na powstanie epizodu niedokrwiennego przez trening fizyczny pacjenta czy farmakoterapię. Innym podejściem jest bezpośrednie farmakologiczne działanie na miRNA czy rodzinę czynników transkrypcyjnych NRF2. Kardioprotekcja śródoperacyjna dotyczy zarówno zabiegów kardiochirurgicznych, jak i niekardiochirurgicznych. Kluczowe w przypadku operacji kardiochirurgicznych jest zastosowanie odpowiedniego roztworu kardiopleginy oraz protokołu jej podawania. Ostatnie badania koncentrują się zwłaszcza na zastosowaniu kardiopleginy del Nido, która pozwala na wydłużenie bezpiecznego niedokrwienia mięśnia sercowego nawet do 120 min w grupie pacjentów wyższego ryzyka. Stosowanie trimetazydyny pozwala na ograniczenie ryzyka sercowo-naczyniowego w grupie starszych pacjentów po operacjach, a podawanie alfacalcidolu przed operacjami zastawkowymi zmniejsza ryzyko powikłań okołozabiegowych. Wywoływanie u zwierząt stanów patologicznych pozwala testować związki mogące przeciwdziałać tym zjawiskom lub zmniejszać ich nasilenie. Związki takie jak disulfiram, krocyna, stachydryna, gossypina, czy też metformina w połączeniu z wodorem mogą zmniejszać ryzyko nie tylko powikłań sercowo- -naczyniowych, ale także zmniejszać remodeling serca. Kardioprotekcja ma duże znaczenie w populacji pacjentów poniżej 18 r.ż. z uwagi na skutki niektórych terapii powodujących jatrogenne uszkodzenia mięśnia sercowego. Podawanie deksrazoksanu czy glutationu w połączeniu z terapią doksarubicyną pozwala ograniczyć uszkodzenie miokardium u dzieci, nie zmniejszając skuteczności działania chemioterapeutyku. Wykazano również działanie kardioprotekcyjne karwedilolu, kaptoprylu, simwastatyny i L-karnityny oraz niektórych suplementów.

Keywords

PL

kardiochirurgia; onkologia dziecięca; chirurgia naczyniowa; kardioprotekcja; uszkodzenie reperfuzyjne; MIRI; kardioprotekcja pediatryczna

EN

pediatric oncology; reperfusion injury; carioprotection; cardiosurgery; vascular surgery; pediatric cardioprotection

• Publisher: Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie
• Journal: Państwo i Społeczeństwo
• Year: 2024
• Volume: XXIV
• Issue: 2
• Pages: 137-151

Dates

published

2024

Contributors

author

Bartosz Andrzej Kuźlik

• Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie

author

Małgorzata Gawlak

• Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie

author

Marta Mazur

• Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie

author

Katarzyna Ciesielska

• Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie

author

Piotr Buszman

• Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie

author

Krzysztof Sanetra

• Uniwersytet Andrzeja Frycza Modrzewskiego w Krakowie

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Identifiers

DOI

10.48269/2451-0858-pis-2024-2-010

Biblioteka Nauki

59581502