Oleh Admin Kalbe Medical pada February 17, 2017 07:30

Manfaat GSE dan Vitamin C pada Pasien CABG

Operasi pintas jantung (CABG/coronary artery bypass graft) secara umum melibatkan pintas kardiopulmoner (CPB) dengan henti kardioplegik dan iskemia global elektif dari jantung. Operasi ini merupakan salah satu prosedur yang telah terbukti untuk revaskularisasi arteri koroner pada sejumlah besar pasien dengan penyakit jantung kongenital berat. Namun, profil pasien yang menjalani operasi CABG berubah dengan peningkatan risiko yang lebih tinggi, yang menyebabkan morbiditas dan mortalitas yang bermakna pada kelompok pasien ini. Penyebab injuri miokardium mungkin multifaktorial dan ateroembolisasi, injuri langsung akibat penanganan dan retraksi jantung, inflamasi sistemik, dan penggunaan intracoronary shunt.

Telah diketahui dengan baik bahwa stres oksidatif merupakan salah satu inisiator injuri miokardium selama iskemia dan reperfusi, dan dapat meningkatkan kadar spesies oksigen reaktif (ROS) beberapa kali lipat yang dapat menyebabkan apoptosis. Grape seed extract (GSE) merupakan antioksidan alami yang lebih kuat dibanding vitamin E dan C. Telah dilaporkan bahwa GSE aman dan beberapa studi telah menunjukkan efek kardioprotektif dari GSE yang bermanfaat dalam melawan injuri yang diinduksi reperfusi melalui kemampuannya untuk mengurangi atau menghilangkan radikal bebas dalam miokardium yang direperfusi setelah iskemia. Vitamin C juga merupakan salah satu antioksidan makanan utama yang dapat mengurangi stres oksidatif.

Suatu studi telah dilakukan pertama kalinya untuk menguji manfaat GSE dan vitamin C pada stres oksidatif dan injuri reperfusi yang disebabkan oleh pintas kardiopulmoner (CPB) pada operasi CABG. Studi tersebut melibatkan 87 pasien yang menjalani operasi CABG elektif dan terisolasi. Pasien secara acak dibagi menjadi kelompok kontrol tanpa terapi, kelompok GSE yang mendapat GSE 24 jam sebelum operasi, 100 mg setiap 6 jam, per oral, dan kelompok vitamin C yang mendapat 25 mg/kg vitamin C melalui CPB selama operasi. Sampel darah diambil dari sinus koroner sebelum klem lintas aorta (T1), sebelum mulai reperfusi pangkal aorta terkontrol (T2), dan 10 menit setelah reperfusi pangkal aorta (T3). Kemudian beberapa parameter klinis dan petanda biokimia dibandingkan di antara ketiga kelompok.

Hasilnya menunjukkan bahwa terdapat perbedaan yang bermakna pada waktu intubasi trakea, kembalinya ritme sinus, dan fungsi ventrikel kiri antara kelompok terapi dibanding kelompok kontrol (p<0,05). Kapasitas antioksidan total lebih tinggi (p<0,05) pada kelompok GSE dan vitamin C pada waktu T2 dan T3. Pada periode reperfusi, kadar malondialdehyde meningkat pada kelompok kontrol, namun lebih rendah secara bermakna pada kelompok GSE (p=0,04). Perbedaan kadar SOD (superoxide dismutase) dan glutathione peroxidase rata-rata antara ketiga kelompok tidak bermakna (p>0,05 pada semua kasus).

Disimpulkan bahwa GSE dan vitamin C mempunyai efek antioksidan dan menurunkan efek yang merusak dari CPB selama operasi CPBG. (EKM)

Image :Ilustrasi
Referensi:
1.Safaei N, Babaei H, Azarfarin R, Jodati AR, Yaghoubi A, Sheikhalizadeh MA. Comparative effect of grape seed extract (Vitis vinifera) and ascorbic acid in oxidative stress induced by on-pump coronary artery bypass surgery. Ann Card Anaesth. 2017;20(1):45-51.
2.Pataki T, Bak I, Kovacs P, Bagchi D, Das DK, Tosaki A. Grape seed proanthocyanidins improved cardiac recovery during reperfusion after ischemia in isolated rat hearts. Am J Clin Nutr. 2002;75(5):894-9.

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