Lipid peroxidation in cardiac surgery

Towards consensus on biomonitoring, diagnostic tools and therapeutic implementation

Rosalba Romano, Simona M. Cristescu, Terence H Risby, Nandor Marczin

Research output: Contribution to journalArticle

Abstract

This review focuses on oxidative stress and more specifically lipid peroxidation in cardiac surgery, one of the fundamental theories of perioperative complications. We present the molecular pathways leading to lipid peroxidation and integrate analytical methods that allow detection of lipid peroxidation markers in the fluid phase with those focusing on volatile compounds in exhaled breath. In order to explore the accumulated data in the literature, we present a systematic review of quantitative analysis of malondialdehyde, a widely used lipid peroxidation product at various stages of cardiac surgery. This exploration reveals major limitations of existing studies in terms of variability of reported values and significant gaps due to discrete and variable sampling times during surgery. We also appraise methodologies that allow real-time and continuous monitoring of oxidative stress. Complimentary techniques highlight that beyond the widely acclaimed contribution of the cardiopulmonary bypass technology and myocardial reperfusion injury, the use of diathermy contributes significantly to intraoperative lipid peroxidation. We conclude that there is an urgent need to implement the theory of oxidative stress towards a paradigm change in the clinical practice. Firstly, we need to acquire definite and irrefutable information on the link between lipid peroxidation and post-operative complications by building international consensus on best analytical approaches towards generating qualitatively and quantitatively comparable datasets in coordinated multicentre studies. Secondly, we should move away from routine low-risk surgeries towards higher risk interventions where there is major unmet clinical need for improving patient journey and outcomes. There is also need for consensus on best therapeutic interventions which could be tested in convincing large scale clinical trials. As future directions, we propose combination of fluid phase platforms and 'metabography', an extended form of capnography - including real-time analysis of lipid peroxidation and volatile footprints of metabolism - for better patient phenotyping prior to and during high risk surgery towards molecular prediction, stratification and monitoring of the patient's journey.

Original languageEnglish (US)
Article number027109
JournalJournal of Breath Research
Volume12
Issue number2
DOIs
StatePublished - Apr 1 2018

Fingerprint

Environmental Monitoring
Lipid Peroxidation
Thoracic Surgery
Oxidative Stress
Therapeutics
Capnography
Diathermy
Myocardial Reperfusion Injury
Physiologic Monitoring
Malondialdehyde
Cardiopulmonary Bypass
Multicenter Studies
Clinical Trials
Technology

Keywords

  • cardiac surgery
  • cardiopulmonary bypass
  • diathermy
  • exhaled breath
  • lipid peroxidation
  • myocardial reperfusion

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Lipid peroxidation in cardiac surgery : Towards consensus on biomonitoring, diagnostic tools and therapeutic implementation. / Romano, Rosalba; Cristescu, Simona M.; Risby, Terence H; Marczin, Nandor.

In: Journal of Breath Research, Vol. 12, No. 2, 027109, 01.04.2018.

Research output: Contribution to journalArticle

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