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The Role of Sodium‐Hydrogen Ion Exchange in Patients Undergoing Coronary Artery Bypass Grafting
Author(s) -
Bolli Roberto
Publication year - 2003
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1046/j.1540-8191.18.s1.4.x
Subject(s) - medicine , artery , myocardial stunning , ischemia , cardiology , sodium , bypass grafting , sodium–hydrogen antiporter , calcium , chemistry , organic chemistry
Sodium‐hydrogen ion exchange (NHE) is one of the principal mechanisms of restoring intracellular pH following ischemia and reperfusion. However, up‐regulation of the NHE process results in a compensatory increase in the activity of the sodium‐calcium exchanger. Intracellular hypercalcemia, resulting from the exchange of sodium for calcium, precipitates myocardial stunning and cell death. It has been postulated that NHE inhibition can protect the ischemic/reperfused myocardium, and preclinical studies have uniformly supported this concept. The Guard During Ischemia Against Necrosis (GUARDIAN) trial suggested benefits of NHE inhibition in subjects undergoing coronary artery bypass grafting (CABG). The sodium‐hydrogen eXchange inhibition to Prevent coronary Events in acute cardiac conDITIONs (EXPEDITION) trial will further explore the use of cariporide in a randomized, controlled trial of CABG subjects at risk of myocardial necrosis. (J Card Surg 2003; 18:21‐26)