ARYA Atherosclerosis Journal

Evaluation of Vasodilatory Effect of Nitroglycerin in Cardioplegia Solution on Patients Undergoing Coronary Artery Bypass Graft Surgery

Document Type : Original Article

Authors

Alireza Hosseini 1
Dr. Mehran Shahzamani 1
Fatemeh Amiri 2

1 Department of Surgery, Chamran Cardiovascular and Medical Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

https://doi.org/10.48305/arya.2023.39236.2833
Abstract
INTRODUCTION: This study aimed to evaluate the vasodilatory effect of nitroglycerin (NTG) in cardioplegia solution on changes in troponin I and creatine phosphokinase-MB (CPK-MB) levels during coronary artery bypass graft (CABG) surgery.
METHOD: A randomized controlled double-blind clinical trial was performed on 44 patients who were candidates for CABG surgery. These patients were divided into two groups. In the first group (NTG group), 3 mg/kg NTG was added to the cardioplegia solution, while 10 cc placebo (distilled water) was added to the cardioplegia solution in the second group (control group). Troponin I and CPK-MB levels were then assessed before and after the surgery.
RESULTS: In this study, 72.7% and 27.3% of patients in the NTG group and 68.2% and 31.8% of patients in the control group were male and female, respectively. In addition, 9.1% within the age range of 40-50 years, 27.3% within the age range of 50-60 years, and 63.6% within the age range of more than 60 years were present in the NTG group. Moreover, 18.2% within the age range of 40-50 years, 36.4% within the age range of 50-60 years, and 45.5% within the age range of more than 60 years were present in the control group. Although the mean cardiopulmonary bypass (CPB) and cross-clamp time was insignificantly higher in the NTG group compared to the control group. In addition, troponin I and CPK-MB levels after surgery in the NTG group with the mean of 2090.68 ± 1856.07 and 97.27 ± 38.17 were significantly lower than those of the control group with the mean of 2697.02 ± 5586.56 and 137.95 ± 227.99, respectively (P-value <0.05).
CONCLUSION: According to the results of this study, although troponin I and CPK-MB levels increased significantly after CABG surgery, this increase was significantly lower in the intervention group compared to the control group following the administration of NTG.
 

Keywords

Nitroglycerin
Troponin I
CPK-MB
Cardioplegia
Coronary artery bypass graft surgery
1. Ras K, Burton B, Swenson D, MacLeod R. Spatial organization of acute myocardial ischemia. J Electrocardiol 2016; 49(3): 323-36. https://doi.org/10.1016/j.jelectrocard.2016.02.014
2. Lindsey ML, Bolli R, Canty JM Jr, Du XJ, Frangogiannis NG, Frantz S, et al. Guidelines for experimental models of myocardial ischemia and infarction. Am J Physiol Heart Circ Physiol 2018; 314(4): H812-H38.https://doi.org/10.1152/ajpheart.00335.2017
3. Hu X, Ma R, Lu J, Zhang K, Xu W, Jiang H, et al. IL-23 promotes myocardial I/R injury by increasing the inflammatory responses and oxidative stress reactions. Cell Physiol Biochem 2016; 38(6): 2163-72.https://doi.org/10.1159/000445572
4. Basgut B, Kayki G, Bartosova L, Ozakca I, Seymen A, Kandilci HB, et al. Cardioprotective effects of 44Bu, a newly synthesized compound, in rat heart subjected to ischemia/reperfusion injury. Eur J Pharmacol 2010; 640(1-3): 117-23. https://doi.org/10.1016/j.ejphar.2010.04.045
5. Jaegere PP, Suyker WJL. Off Pump coronary artery bypass surgery. Heart 2002; 88: 313-318. https://doi.org/10.1136/heart.88.3.313
6. Wu W, Lai L, Xie M, Qiu H. Insights of heat shock protein 22 in the cardiac protection against ischemic oxidative stress. Redox Biol 2020; 34: 101555. https://doi.org/10.1016/j.redox.2020.101555
7. Carlucci F, Tabucchi A, Biagioli B, Simeone F, Scolletta S, Rosi F, et al. Cardiac surgery: myocardial energy balance, antioxidant status and endothelial function ‎after ischemia-reperfusion. Biomed Pharmacother 2002; 56(10): 483-91. https://doi.org/10.1016/S0753-3322(02)00286-X
8. Lee P, Chandel NS, Simon MC. Cellular adaptation to hypoxia through hypoxia inducible factors and beyond. Nat Rev Mol Cell Biol 2020; 21(5): 268-83.https://doi.org/10.1038/s41580-020-0227-y
9. Gallo G, Pierelli G, Forte M, Coluccia R, Volpe M, Rubattu S. Role of oxidative stress in the process of vascular remodeling following coronary revascularization. Int J Cardiol 2018; 268: 27-33.https://doi.org/10.1016/j.ijcard.2018.05.046
10. Chan CK, Mak J, Gao Y, Man RY, Vanhoutte PM. Endothelium-derived NO, but not cyclic GMP, is required for hypoxic augmentation in isolated porcine coronary arteries. Am J Physiol Heart Circ Physiol 2011; 301(6): H2313-H21. https://doi.org/10.1152/ajpheart.00258.2011
11. Cayir MC, Yuksel A. The use of del Nido cardioplegia for myocardial protection in isolated coronary artery bypass surgery. Heart Lung Circ 2020; 29(2): 301-7.https://doi.org/10.1016/j.hlc.2018.12.006
12. Yavuz T, Altuntas I, Odabasi D, Delibas N, Ocal A, Ibrisim E, et al. Beneficial effect of the addition of nitroglycerin to the cardioplegic solution on lipid peroxidation during coronary artery bypass surgery. Int Heart J 2005; 46(1): 45-55. https://doi.org/10.1536/ihj.46.45
13. Fontes-Guerra PC, Cardoso CR, Muxfeldt ES, Salles GF. Nitroglycerin-mediated, but not flow-mediated vasodilation, is associated with blunted nocturnal blood pressure fall in patients with resistant hypertension. J Hypertens 2015; 33(8): 1666-75.https://doi.org/10.1097/HJH.0000000000000589
14. Qin X, Zheng X, Qi H, Dou D, Raj JU, Gao Y. cGMP-dependent protein kinase in regulation of basal tone and in nitroglycerin-and nitric-oxide-induced relaxation in porcine coronary artery. Pflugers Arch 2007; 454(6): 913-23. https://doi.org/10.1007/s00424-007-0249-8
15. Paone S, Clarkson L, Sin B, Punnapuzha S. Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. Am J Emerg Med 2018; 36(8): 1526. e5-e7. https://doi.org/10.1016/j.ajem.2018.05.013
16. Liu H, Li Y, An Y, He P, Wu L, Gao Y, et al. Endothelium-independent hypoxic ‎contraction is prevented specifically by Nitroglycerin via inhibition of Akt kinase in porcine coronary artery. Stem Cells Int 2016; 2016. https://doi.org/10.1155/2016/2916017
17. Mehlhorn U, Krahwinkel A, Geissler HJ, LaRosee K, Fischer UM, Klass O, et al. ‎Nitrotyrosine and 8-isoprostane formation indicate free radical-mediated injury in ‎hearts of patients subjected to cardioplegia. J Thorac Cardiovasc Surg 2003; 125(1): 178-83. https://doi.org/10.1067/mtc.2003.97
18. Kiziltepe U, Tunçtan B, Eyileten ZB, Sirlak M, Arikbuku M, Tasoz R, et al. Efficiency of l-arginine enriched cardioplegia and non-cardioplegic reperfusion in ischemic hearts. Int J Cardiol 2004; 97(1): 93-100.https://doi.org/10.1016/j.ijcard.2003.08.015
19. Nemati MH, Badie H, Jannati M. Investigation of Impact of Trinitroglycerin Conjugated Cardioplegia on Myocardial Protection of Patients with Coronary Artery Bypass Grafting. Acta Med Iran 2019: 586-91.https://doi.org/10.18502/acta.v57i10.3246
20. Plicner D, Stoliński J, Rzucidło-Hymczak A, Kapelak B, Undas A. Acute-phase proteins and oxidative stress in patients undergoing coronary artery bypass graft: comparison of cardioplegia strategy. Kardiochir Torakochirurgia Pol 2017; 14(1): 16-21. https://doi.org/10.5114/kitp.2017.66924
21. Mishra P, Jadhav RB, Mohapatra CK, Khandekar J, Raut C, Ammannaya GK, et al., Comparison of del Nido cardioplegia and St. Thomas Hospital solution-two types of cardioplegia in adult cardiac surgery. Kardiochir Torakochirurgia Pol 2016; 13(4): 295-9.https://doi.org/10.5114/kitp.2016.64867
22. Checchia PA, Bronicki RA, Muenzer JT, Dixon D, Raithel S, Gandhi SK, et al., Nitric oxide delivery during cardiopulmonary bypass reduces postoperative morbidity in children-a randomized trial. J Thorac Cardiovasc Surg 2013; 146(3): 530-6. https://doi.org/10.1016/j.jtcvs.2012.09.100
23. Panigrahi D, Roychowdhury S, Guhabiswas R, Rupert E, Das M, Narayan P. Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 2018; 26(4): 267-72.https://doi.org/10.1177/0218492318773589
24. du Fay de Lavallaz J, Zehntner T, Puelacher C, Walter J, Strebel I, Rentsch K, et al., Rhabdomyolysis: a noncardiac source of increased circulating concentrations of ‎cardiac troponin T?. J Am Coll Cardiol 2018; 72(23 Part A): 2936-7. https://doi.org/10.1016/j.jacc.2018.09.050
25. Yavuz T, Altuntas I, Odabasi D, Delibas N, Ocal A, Ibrisim E, et al. Beneficial effect of ‎the addition of nitroglycerin to the cardioplegic solution on lipid peroxidation during coronary artery bypass surgery. Int Heart J 2005; 46(1): 45-55. https://doi.org/10.1536/ihj.46.45
26. Hisotami K, Maruyama H, Isomura T, Aoyagi S, Kasuga K, Ohishi F. Beneficial effect ‎of the addition of nitroglycerin to the cardioplegic solution on the cold-stored reperfused isolated rat heart. Jpn Circ J 1993; 57: 558-62. https://doi.org/10.1253/jcj.57.558
27. Farag M, Shoaib A, Gorog DA. Nitrates for the management of acute heart failure ‎syndromes, a systematic review. J Cardiovasc Pharmacol Ther 2017; 22(1): 20-7. https://doi.org/10.1177/1074248416644345
28. Salerno PR, Jatene FB, Figueiredo PE, Bosisio IJ, Jatene MB, Santos MA, et al., The behavior of Troponin I and CKMB mass in children who underwent surgical ‎correction of congenital heart malformations. Braz J Cardiovasc Surg 2003; 18: 235-41. https://doi.org/10.1590/S0102-76382003000300008
29. Yu X, Ge L, Niu L, Lian X, Ma H, Pang L. The dual role of inducible nitric oxide synthase in myocardial ischemia/reperfusion injury: friend or foe?. Oxid Med Cell Longev 2018; 2018. https://doi.org/10.1155/2018/8364848
30. Radi R. The origins of nitric oxide and peroxynitrite research in Uruguay: 25 years of contributions to the biochemical and biomedical sciences. Nitric Oxide 2019; 87: 83-9. https://doi.org/10.1016/j.niox.2019.03.003
ARYA Atherosclerosis Journal
Volume 19, Issue 3
May 2023
Pages 25-32

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us