Study Of Caspase-3/Caspase-12 Expression On The Sugery Of Mitral Value Replacemente During Beating Heart And The Expression Of CSE After Myocardial Ischemia

Objective To research the cardiopulmonary bypass(CPB) cardiac arrest surgery and beating heart surgery lead to myocardial ischemia-reperfusion injury(MIRI) degree and the extent of apoptosis in myocardial cell.Observeing the influence at different operation which differential expression mediated myocardial apoptosis by Caspase (cysteine-containing aspartate-specific protease) family members Capsase-3 and Caspase-12.Simple discussion the mechanisms who protected by cystathionine-y-lyase(CSE) after myocardial ischemia and providing clinical evidence and new ideas for the future of myocardial protection in cardiac surgery.Methods 40 patients with in Firist affiliated Hospital of Guangxi Medical University RHD(rheumatic heart disease) MS(mitral stenosis) were randomly divided into BH group(beating heart group, n=20) and CA group(cardiac arrest group,n=20), both of them were accepted MVR(mitral valve replacement) by beating heart surgery and cardiac arrest surgery under CPB respectively.BH group only for the vena cava blocking but not for aorta and perfusion cardioplegia.Right atrial myocardial tissue were collected at prior the start of CPB(To), after aortic cross-clamping 30 minutes(BH group to take the corresponding time, T1) and stitched right atrium(T2) respectively.Using the method of rt-PCR (reverse transcriptase polymerase chain reaction) detection the expression levels of Caspase-3,Caspase-12 and CSE at three time periods in two groups.Observing the two groups myocardial tissue slices positive expression about the Caspase-3 and Caspase-12 by the method of immunohistochemical,TUNEL method were used to detected the situation of myocardial apoptosis.Recording the time of clicinal data in both groups during operation include CPB bypass time, vena cava blocking time, aortic cross-clamping (BH group’s corresponding) time, open the aortic suture to the right atrium suture (after shutdown) time and the information of postoperative clinical data about the ventilation time of ventilator,hospital stay and so on.Recording the data of echocardiography about the two groups in preoperative and postoperative including MVA (mitral valve area), MTP(mitral transvalvular pressure),CO(cardiac output),EF(ejection fraction),LAD(left atrial diameter), LVEDD(left ventricular end-diastolic diameter, LVEDD),and LVEDV(left ventricular end-diastolic volume).Using SPSS 17.0 statistical software to process data and the difference was statistically significant as P<0.05.Results (1) All the patients rehabilitation after treatment,CPB bypass time, vena cava blocking time and ventilator time in BH group were less than CA group (P<0.05).Postoperative about MVA, MTP, CO, LAD, LVEDV in the two groups and EF in BH group improved significantly compared with the preoperative(P<0.05).The improving effect on CO and EF were batter than CA.(2) The expression of Caspase-3 in BH group had increased in T2(P <0.05).Caspase-3 in CA group expressed a little at T1 but significantly increased in T2(P<0.05).Caspase-3 in CA group expressed significantly higher than the BH group at T2(P<0.05).The expression of Caspase-12 in BH group had increased in T2(P<0.05).Caspase-12 in CA group had increased in Ti and significantly increased in T2(P<0.05).Caspase-12 in CA group expressed higher than BH group at Ti and T2(P<0.05).The expression of CSE in BH group had increased in T2(P<0.05), CSE in CA group expressed increased in Ti but reduced significantly at T2(P<0.05).The expression of CSE in CA group was significantly higher than BH group at T1 but lower than BH group at T2.(3) The number of positive staining about Caspase-3 had increased in two groups at T2(P<0.05) and CA group at T2 was significantly higher than BH group (P<0.05).The number of positive staining about Caspase-12 had increased in two groups at T2(P<0.05) and CA group at T2 was significantly higher than BH group (P<0.05).(4) Both of the two groups at T2 cardiomyocytes apoptosis had appeared in varying degrees and the apoptosis index in CA group was significantly higher than BH group(P<0.05).Conclusion (1) The time of CPB bypass and ventilator in beating heart MVR were less than cardiac arrest.The EF and CO improved batter.(2) Beating heart surgery can relieve the cause of MIRI by CPB which Caspase-3 and Caspase-12 participate in mediating myocardial apoptosis, better myocardial protection.(3) After myocardial ischemia the expression of CSE had increased may play an important role on protective mechanism about the ischemic myocardium.