Stress caused by cardioplegic ischemic arrest was shown to alter the expression levels of heat shock proteins (Hsp), but little is known about their effects, particularly on pediatric hearts. This study aimed to investigate whether myocardial cellular stress and apoptotic response changes due to different cardioplegia (CP) solutions during cardiopulmonary bypass (CPB) in infants and to determine their influence on surgical/clinical outcomes. Therefore, twenty-seven infants for surgical closure of ventricular septal defect were randomly assigned to a CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol (CCP). Hsp levels and apoptosis were determined by immunoblotting in cardiac tissue from the right atrium before and after CP, and their correlations with cardiac parameters were evaluated. No significant change was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased significantly in the BCP-group but increased markedly in the CCP-group. Decreased Hsp60 and increased Hsp70 expression were detected in dNCP-group. Importantly, apoptosis was not observed in dNCP- and CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury marker, was markedly lower in the BCP- and dNCP-groups than CCP. Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated with aortic cross-clamp time, total perfusion time, and cTn-I release. Our findings show that dNCP provides the most effective myocardial preservation in pediatric open-heart surgery and indicate that an increase in Hsp70 expression may be associated with a cardioprotective effect, while an increase in Hsp60 and Hsp90 levels may be an indicator of myocardial damage during CPB.

心脏停搏性缺血性骤停引起的压力被证明会改变热休克蛋白 (Hsp) 的表达水平，但对其影响知之甚少，尤其是对儿童心脏的影响。本研究旨在调查婴儿体外循环 (CPB) 期间不同的心脏停搏 (CP) 溶液是否会导致心肌细胞应激和凋亡反应发生变化，并确定它们对手术/临床结果的影响。因此，27 名接受室间隔缺损手术闭合的婴儿被随机分配到 CP 溶液：常温血 (BCP)、delNido (dNCP) 和 Custodiol (CCP)。通过免疫印迹法测定 CP 前后右心房心脏组织的 Hsp 水平和细胞凋亡，并评估它们与心脏参数的相关性。Hsp27 水平未观察到显着变化。Hsp60、Hsp70 和 Hsp90 水平在 BCP 组中显着降低，但在 CCP 组中显着升高。在 dNCP 组中检测到 Hsp60 降低和 Hsp70 表达增加。重要的是，在 dNCP 组和 CCP 组中未观察到细胞凋亡，而在 BCP 后确定切割的 caspase-3 和 -8 显着增加。血清心肌肌钙蛋白-I (cTn-I)，心肌损伤标志物，在 BCP 和 dNCP 组中明显低于 CCP。此外，Hsp60、Hsp70 和 Hsp90 水平与主动脉交叉钳夹时间、总灌注时间和 cTn-I 释放呈正相关。我们的研究结果表明，dNCP 在小儿心脏直视手术中提供了最有效的心肌保护，并表明 Hsp70 表达的增加可能与心脏保护作用有关，