Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery

Randomized trial

Nikolay O. Kamenshchikov, Irina A. Mandel, Yuriy K. Podoksenov, Yulia S. Svirko, Vladimir V. Lomivorotov, Sergey L. Mikheev, Boris N. Kozlov, Vladimir M. Shipulin, Aleksandra A. Nenakhova, Yana J. Anfinogenova

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: The aim of this pilot study was to elucidate the effects of exogenous nitric oxide (NO) supply to the extracorporeal circulation circuit for cardioprotection against ischemia–reperfusion injury during coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: A total of 60 patients with coronary artery disease scheduled for CABG with CPB were enrolled in a prospective randomized study. Patients were allocated randomly to receive treatment according to standard or modified CPB protocol where 40-ppm NO was added to the CPB circuit during cardiac surgery. The primary endpoint was the measurement of cardiac troponin I (cTnI). The secondary end points consisted in the measurements of creatine kinase-muscle/brain fraction (CK-MB) and vasoactive inotropic score (VIS). Results: NO delivered into the CPB circuit had a cardioprotective effect. The level of cTnI was significantly lower in NO-treated group compared with the control group 6 hours after surgery: 1.79 ± 0.39 ng/mL versus 2.41 ± 0.55 ng/mL, respectively (P = .001). The CK-MB value was significantly lower in NO-treated group compared with the control group 24 hours after surgery: 47.69 ± 8.08 U/L versus 62.25 ± 9.78 U/L, respectively (P = .001); and the VIS was significantly lower in the NO-treated group 6 hours after the intervention. Conclusions: NO supply to the CPB circuit during CABG exerted a cardioprotective effect and was associated with lower levels of VIS and cardiospecific blood markers cTnI and CK-MB.

Original languageEnglish
Pages (from-to)2328-2336.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Fingerprint

Cardiopulmonary Bypass
Thoracic Surgery
Nitric Oxide
BB Form Creatine Kinase
MM Form Creatine Kinase
Troponin I
Coronary Artery Bypass
Control Groups
Extracorporeal Circulation
Coronary Artery Disease
Prospective Studies
Wounds and Injuries

Keywords

  • cardioprotection
  • cardiopulmonary bypass
  • coronary artery bypass grafting
  • ischemia–reperfusion injury
  • nitric oxide

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery : Randomized trial. / Kamenshchikov, Nikolay O.; Mandel, Irina A.; Podoksenov, Yuriy K.; Svirko, Yulia S.; Lomivorotov, Vladimir V.; Mikheev, Sergey L.; Kozlov, Boris N.; Shipulin, Vladimir M.; Nenakhova, Aleksandra A.; Anfinogenova, Yana J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 6, 01.06.2019, p. 2328-2336.e1.

Research output: Contribution to journalArticle

Kamenshchikov, NO, Mandel, IA, Podoksenov, YK, Svirko, YS, Lomivorotov, VV, Mikheev, SL, Kozlov, BN, Shipulin, VM, Nenakhova, AA & Anfinogenova, YJ 2019, 'Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery: Randomized trial', Journal of Thoracic and Cardiovascular Surgery, vol. 157, no. 6, pp. 2328-2336.e1. https://doi.org/10.1016/j.jtcvs.2018.08.117
Kamenshchikov, Nikolay O. ; Mandel, Irina A. ; Podoksenov, Yuriy K. ; Svirko, Yulia S. ; Lomivorotov, Vladimir V. ; Mikheev, Sergey L. ; Kozlov, Boris N. ; Shipulin, Vladimir M. ; Nenakhova, Aleksandra A. ; Anfinogenova, Yana J. / Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery : Randomized trial. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 6. pp. 2328-2336.e1.
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abstract = "Objectives: The aim of this pilot study was to elucidate the effects of exogenous nitric oxide (NO) supply to the extracorporeal circulation circuit for cardioprotection against ischemia–reperfusion injury during coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: A total of 60 patients with coronary artery disease scheduled for CABG with CPB were enrolled in a prospective randomized study. Patients were allocated randomly to receive treatment according to standard or modified CPB protocol where 40-ppm NO was added to the CPB circuit during cardiac surgery. The primary endpoint was the measurement of cardiac troponin I (cTnI). The secondary end points consisted in the measurements of creatine kinase-muscle/brain fraction (CK-MB) and vasoactive inotropic score (VIS). Results: NO delivered into the CPB circuit had a cardioprotective effect. The level of cTnI was significantly lower in NO-treated group compared with the control group 6 hours after surgery: 1.79 ± 0.39 ng/mL versus 2.41 ± 0.55 ng/mL, respectively (P = .001). The CK-MB value was significantly lower in NO-treated group compared with the control group 24 hours after surgery: 47.69 ± 8.08 U/L versus 62.25 ± 9.78 U/L, respectively (P = .001); and the VIS was significantly lower in the NO-treated group 6 hours after the intervention. Conclusions: NO supply to the CPB circuit during CABG exerted a cardioprotective effect and was associated with lower levels of VIS and cardiospecific blood markers cTnI and CK-MB.",
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T1 - Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery

T2 - Randomized trial

AU - Kamenshchikov, Nikolay O.

AU - Mandel, Irina A.

AU - Podoksenov, Yuriy K.

AU - Svirko, Yulia S.

AU - Lomivorotov, Vladimir V.

AU - Mikheev, Sergey L.

AU - Kozlov, Boris N.

AU - Shipulin, Vladimir M.

AU - Nenakhova, Aleksandra A.

AU - Anfinogenova, Yana J.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objectives: The aim of this pilot study was to elucidate the effects of exogenous nitric oxide (NO) supply to the extracorporeal circulation circuit for cardioprotection against ischemia–reperfusion injury during coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: A total of 60 patients with coronary artery disease scheduled for CABG with CPB were enrolled in a prospective randomized study. Patients were allocated randomly to receive treatment according to standard or modified CPB protocol where 40-ppm NO was added to the CPB circuit during cardiac surgery. The primary endpoint was the measurement of cardiac troponin I (cTnI). The secondary end points consisted in the measurements of creatine kinase-muscle/brain fraction (CK-MB) and vasoactive inotropic score (VIS). Results: NO delivered into the CPB circuit had a cardioprotective effect. The level of cTnI was significantly lower in NO-treated group compared with the control group 6 hours after surgery: 1.79 ± 0.39 ng/mL versus 2.41 ± 0.55 ng/mL, respectively (P = .001). The CK-MB value was significantly lower in NO-treated group compared with the control group 24 hours after surgery: 47.69 ± 8.08 U/L versus 62.25 ± 9.78 U/L, respectively (P = .001); and the VIS was significantly lower in the NO-treated group 6 hours after the intervention. Conclusions: NO supply to the CPB circuit during CABG exerted a cardioprotective effect and was associated with lower levels of VIS and cardiospecific blood markers cTnI and CK-MB.

AB - Objectives: The aim of this pilot study was to elucidate the effects of exogenous nitric oxide (NO) supply to the extracorporeal circulation circuit for cardioprotection against ischemia–reperfusion injury during coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: A total of 60 patients with coronary artery disease scheduled for CABG with CPB were enrolled in a prospective randomized study. Patients were allocated randomly to receive treatment according to standard or modified CPB protocol where 40-ppm NO was added to the CPB circuit during cardiac surgery. The primary endpoint was the measurement of cardiac troponin I (cTnI). The secondary end points consisted in the measurements of creatine kinase-muscle/brain fraction (CK-MB) and vasoactive inotropic score (VIS). Results: NO delivered into the CPB circuit had a cardioprotective effect. The level of cTnI was significantly lower in NO-treated group compared with the control group 6 hours after surgery: 1.79 ± 0.39 ng/mL versus 2.41 ± 0.55 ng/mL, respectively (P = .001). The CK-MB value was significantly lower in NO-treated group compared with the control group 24 hours after surgery: 47.69 ± 8.08 U/L versus 62.25 ± 9.78 U/L, respectively (P = .001); and the VIS was significantly lower in the NO-treated group 6 hours after the intervention. Conclusions: NO supply to the CPB circuit during CABG exerted a cardioprotective effect and was associated with lower levels of VIS and cardiospecific blood markers cTnI and CK-MB.

KW - cardioprotection

KW - cardiopulmonary bypass

KW - coronary artery bypass grafting

KW - ischemia–reperfusion injury

KW - nitric oxide

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