{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:17Z","timestamp":1787028917333,"version":"build-2736575974"},"reference-count":13,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T00:00:00Z","timestamp":1727136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The majority of cardiac surgical procedures are performed using cardiopulmonary bypass and cardioplegia-induced cardiac arrest. Cardiac arrest and reperfusion may lead to ischemia-reperfusion injury of the myocardium. The aim of this study was to investigate whether gradual reperfusion with a slow increase in oxygen partial pressure leads to a reduction in reperfusion injury. Materials and Methods: Fifty patients undergoing elective cardiac surgery were included in this prospective randomized study. Patients in the hyperoxemic (control) group received conventional reoxygenation (paO2 250\u2013300 mmHg). Patients in the normoxemic (study) group received gradual reoxygenation (1st-minute venous blood with paO2 30\u201340 mmHg, 2nd-minute arterial blood with paO2 100\u2013150 mmHg). Periprocedural blood samples were taken serially, and markers of myocardial injury were analyzed. In addition, the influence of gradual reoxygenation on hemodynamics, inflammation, and the overall perioperative course was evaluated. Results: There was a trend toward higher CK levels in the hyperoxemia group without statistical significance; however, CK-MB and troponin T levels did not show any statistical difference between the two groups. Potassium concentrations in the coronary sinus were significantly higher in the hyperoxemia group at 3 and 8 min after opening of the aortic cross-clamp (6.88 \u00b1 0.87 mmol\/L vs. 6.30 \u00b1 0.91 mmol\/L and 5.87 \u00b1 0.73 mmol\/L vs. 5.43 \u00b1 0.42 mmol\/L, respectively; p = 0.03 and p = 0.02). All other measurements did not show a statistical difference between the two groups. Conclusions: The use of gradual reperfusion in cardiac surgery with cardiopulmonary bypass and cardiac arrest is safe. However, it does not reduce ischemia-reperfusion injury compared to standard hyperoxemic reperfusion.<\/jats:p>","DOI":"10.3390\/medicina60101564","type":"journal-article","created":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T08:54:17Z","timestamp":1727168057000},"page":"1564","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest"],"prefix":"10.3390","volume":"60","author":[{"given":"Mascha","family":"von Zeppelin","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Hecker","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Clinical Perfusion, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3578-6501","authenticated-orcid":false,"given":"Jan","family":"Hlavicka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Walther","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8375-5991","authenticated-orcid":false,"given":"Anton","family":"Moritz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani","family":"Arsalan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"},{"name":"Department of Cardiology and Angiology, Medical Clinic I, University Hospital of the Justus Liebig University, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2366-0880","authenticated-orcid":false,"given":"Tomas","family":"Holubec","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/0002-9343(80)90509-4","article-title":"Oxygen toxicity","volume":"69","author":"Frank","year":"1980","journal-title":"Am. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Feindt, P., Harig, F., and Weyand, M. (2006). Empfehlungen Zum Einsatz Und Zur Verwendung Der Herz-Lungen-Maschine, Steinkopff.","DOI":"10.1007\/3-7985-1646-4"},{"key":"ref_3","first-page":"32","article-title":"Das Gerinnungssystem w\u00e4hrend extrakorporaler Zirkulation","volume":"2","author":"Hartmann","year":"2005","journal-title":"Kardiotechnik"},{"key":"ref_4","unstructured":"Brunkhorst, F.M., Weigand, M., Pletz, M., Gastmeier, P., Lemmen, S.W., Meier-Hellmann, A., and Ragaller, M. (2018, December 31). S3-Leitlinie Sepsis\u2014Pr\u00e4vention, Diagnose, Therapie und Nachsorge. Available online: https:\/\/www.awmf.org\/uploads\/tx_szleitlinien\/079-001k_S3_Sepsis-Praevention-Diagnose-Therapie-Nachsorge_2020-02.pdf."},{"key":"ref_5","first-page":"CR389","article-title":"Graded reoxygenation limits lipid peroxidation during surgical reperfusion","volume":"9","author":"Aybeck","year":"2003","journal-title":"Med. Sci. Monit."},{"key":"ref_6","first-page":"2145","article-title":"Prazosin protects myocardial cells against anoxia-reoxygenation injury via the extracellular signal-regulated kinase signaling pathway","volume":"17","author":"Wang","year":"2018","journal-title":"Mol. Med. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1053\/j.semtcvs.2018.09.018","article-title":"Differential Effects of Normoxic and Hyperoxic Reperfusion on Global Myocardial Ischemia-Reperfusion Injury","volume":"31","author":"Peng","year":"2019","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s13019-020-01173-4","article-title":"Normoxic re-oxygenation ameliorates end-organ injury after cardiopulmonary bypass","volume":"15","author":"Peng","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e400","DOI":"10.1016\/j.bja.2020.06.031","article-title":"Hyperoxia during cardiopulmonary bypass does not increase respiratory or neurological complications: A post hoc analysis of the CARDIOX study","volume":"125","author":"Huette","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1253\/circj.66.718","article-title":"Cardioprotective effects of lowering oxygen tension after aortic unclamping on cardiopulmonary bypass during coronary artery bypass grafting","volume":"66","author":"Inoue","year":"2002","journal-title":"Circ. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Karu, I., T\u00e4hep\u00f5ld, P., Ruusalepp, A., Zilmer, K., Zilmer, M., and Starkopf, J. (2012). Effects of 60 minutes of hyperoxia followed by normoxia before coronary artery bypass grafting on the inflammatory response profile and myocardial injury. J. Negat. Results Biomed., 11.","DOI":"10.1186\/1477-5751-11-14"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/ALN.0000000000001226","article-title":"A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass","volume":"125","author":"McGuinness","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1051\/ject\/200638241","article-title":"Normoxia vs. hyperoxia: Impact of oxygen tension strategies on outcomes for patients receiving cardiopulmonary bypass for routine cardiac surgical repair","volume":"38","author":"Brown","year":"2006","journal-title":"J. Extra Corpor. Technol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/10\/1564\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:01:31Z","timestamp":1760112091000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/10\/1564"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,24]]},"references-count":13,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["medicina60101564"],"URL":"https:\/\/doi.org\/10.3390\/medicina60101564","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,24]]}}}