Investigation of Impact of Trinitroglycerin Conjugated Cardioplegia on Myocardial Protection of Patients With Coronary Artery Bypass Grafting
Abstract
Pharmacologic-conjugated-cardioplegia is one of the strategies against ischemia and reperfusion. The aim of this study was to investigate the impact of nitroglycerin on myocardial protection and postoperative outcomes. This was a case-control study performed on 91 patients undergoing coronary artery bypass grafting in Faghihi Hospital, Shiraz University of Medical Sciences. Patients were randomly divided into case and control groups. Trinitroglycerin Conjugated Cardioplegia on Myocardial Protection of Patients with Coronary Artery Bypass Grafting. As a result of nitroglycerin, the number of patients requiring inotrope administration was increased. No other significant alteration was observed between two groups in neither of ischemic features nor postoperative outcomes. In conclusion, nitroglycerin conjugated cardioplegia, with the condition of this study, demonstrated a negative inotrope requirement without improvement in myocardium protection.
1. Yamamoto H, Yamamoto F. Myocardial protection in cardiac surgery: a historical review from the beginning to the current topics. Gen Thorac Cardiovasc Surg. 2013;61(9):485-96.
2. Collard CD, Gelman S. Pathophysiology, clinical manifestations, and prevention of ischemia-reperfusion injury. Anesthesiology. 2001;94(6):1133-8.
3. Matata BM, Galinanes M. Cardiopulmonary bypass exacerbates oxidative stress but does not increase proinflammatory cytokine release in patients with diabetes compared with patients without diabetes: regulatory effects of exogenous nitric oxide. J Thorac Cardiovasc Surg. 2000;120(1):1-11.
4. van Boven WJ, Gerritsen WB, Driessen AH, Morshuis WJ, Waanders FG, Haas FJ, et al. Myocardial oxidative stress, and cell injury comparing three different techniques for coronary artery bypass grafting. Eur J Cardiothorac Surg. 2008;34(5):969-75.
5. Kalawski R, Balinski M, Bugajski P, Wysocki H, Olszewski R, Siminiak T. Stimulation of neutrophil activation during coronary artery bypass grafting: comparison of crystalloid and blood cardioplegia. Ann Thorac Surg. 2001;71(3):827-31.
6. Kalawski R, Deskur E, Bugajski P, Wysocki H, Siminiak T. Stimulation of neutrophil integrin expression during coronary artery bypass grafting: comparison of crystalloid and blood cardioplegic solutions. J Thorac Cardiovasc Surg. 2000;119(6):1270-7.
7. Poormoghim H, Moghadam AS, Moradi-Lakeh M, Jafarzadeh M, Asadifar B, Ghelman M, et al. Systemic sclerosis: demographic, clinical and serological features in 100 Iranian patients. Rheumatol Int. 2013;33(8):1943-50.
8. Plicner D, Stolinski J, Rzucidlo-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.
9. Barner H. Historical aspects and current review of myocardial protection. Warm heart surgery Ed Salerno, TA Arnold, London. 1995:1-15.
10. Karmazyn M. Amiloride enhances postischemic ventricular recovery: possible role of Na+-H+ exchange. Am J Physiol. 1988;255(3 Pt 2):H608-15.
11. Hendrikx M, Mubagwa K, Verdonck F, Overloop K, Van Hecke P, Vanstapel F, et al. New Na(+)-H+ exchange inhibitor HOE 694 improves postischemic function and high-energy phosphate resynthesis and reduces Ca2+ overload in isolated perfused rabbit heart. Circulation. 1994;89(6):2787-98.
12. Choy IO, Schepkin VD, Budinger TF, Obayashi DY, Young JN, DeCampli WM. Effects of specific sodium/hydrogen exchange inhibitor during cardioplegic arrest. Ann Thorac Surg. 1997;64(1):94-9.
13. Koike A, Akita T, Hotta Y, Takeya K, Kodama I, Murase M, et al. Protective effects of dimethyl amiloride against postischemic myocardial dysfunction in rabbit hearts: phosphorus 31-nuclear magnetic resonance measurements of intracellular pH and cellular energy. J Thorac Cardiovasc Surg. 1996;112(3):765-75.
14. Cox CS, Jr., Sauer H, Allen SJ, Buja LM, Laine GA. Sodium/hydrogen-exchanger inhibition during cardioplegic arrest and cardiopulmonary bypass: an experimental study. J Thorac Cardiovasc Surg. 2002;123(5):959-66.
15. Castella M, Buckberg GD, Tan Z. Blood cardioplegic protection in profoundly damaged hearts: role of Na+-H+ exchange inhibition during pretreatment or during controlled reperfusion supplementation. Ann Thorac Surg. 2003;75(4):1238-45.
16. Sato T, Sasaki N, O'Rourke B, Marban E. Nicorandil, a potent cardioprotective agent, acts by opening mitochondrial ATP-dependent potassium channels. J Am Coll Cardiol. 2000;35(2):514-8.
17. Steensrud T, Jakobsen O, Ytrehus K, Sorlie DG. Contractile recovery of heart muscle after hypothermic hypoxia is improved by nicorandil via mitochondrial K(ATP) channels. Eur J Cardiothorac Surg. 2006;30(2):256-62.
18. Yamamoto S, Yamada T, Kotake Y, Takeda J. Cardioprotective effects of nicorandil in patients undergoing on-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2008;22(4):548-53.
19. Liu R, Xing J, Miao N, Li W, Liu W, Lai Y-Q, et al. The myocardial protective effect of adenosine as an adjunct to intermittent blood cardioplegia during open heart surgery. European Journal of Cardio-Thoracic Surgery. 2009;36(6):1018-23.
20. Dobson GP, Jones MW. Adenosine and lidocaine: a new concept in nondepolarizing surgical myocardial arrest, protection, and preservation. J Thorac Cardiovasc Surg. 2004;127(3):794-805.
21. Sloots KL, Dobson GP. Normokalemic adenosine-lidocaine cardioplegia: importance of maintaining a polarized myocardium for optimal arrest and reanimation. J Thorac Cardiovasc Surg. 2010;139(6):1576-86.
22. Bessho R, Chambers DJ. Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat. J Thorac Cardiovasc Surg. 2002;124(2):340-51.
23. Fujii M, Chambers DJ. Cardioprotection with esmolol cardioplegia: efficacy as a blood-based solution. European Journal of Cardio-Thoracic Surgery. 2012;43(3):619-27.
24. Braathen B, Jeppsson A, Schersten H, Hagen OM, Vengen O, Rexius H, et al. One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study. J Thorac Cardiovasc Surg. 2011;141(4):995-1001.
25. Sezai A, Wakui S, Akiyama K, Hata M, Yoshitake I, Unosawa S, et al. Myocardial protective effect of human atrial natriuretic Peptide in cardiac surgery. -hANP Shot" in clinical safety trial. Circ J. 2011;75(9):2144-50.
26. Katzung BG. Basic & Clinical Pharmacology: McGraw-Hill Medical; 2006.
27. Tanaka T, Kazui T, Komatsu K, Sasaki A, Inoue N, Izumiyama O, et al. [Effects of blood-diltiazem-nitroglycerin-cardioplegia in coronary artery bypass grafting]. Kyobu Geka. 1992;45(11):964-7.
28. McKeown PP, McClelland JS, Bone DK, Jones EL, Kaplan JA, Lutz JF, et al. Nitroglycerin as an adjunct to hypothermic hyperkalemic cardioplegia. Circulation. 1983;68(3 Pt 2):II107-11.
29. Hearse DJ, O'Brien K, Braimbridge MV. Protection of the myocardium during ischemic arrest. Dose-response curves for procaine and lignocaine in cardioplegic solutions. J Thorac Cardiovasc Surg. 1981;81(6):873-9.
30. Preusse CJ, Gebhard MM, Bretschneider HJ. Myocardial "equilibration processes" and myocardial energy turnover during initiation of artificial cardiac arrest with cardioplegic solution - reasons for a sufficiently long cardioplegic perfusion. Thorac Cardiovasc Surg. 1981;29(2):71-6.
31. Bretschneider HJ. Myocardial protection. Thorac Cardiovasc Surg. 1980;28(5):295-302.
32. Fallah S, Seifi M, Firoozrai M, Godarzi T, Jafarzadeh M, Ghohari L. Influence of Apo E polymorphism on coronary artery disease. World Acad Sci Eng Technol. 2009;57.
33. Manning AS, Keogh JM, Coltart DJ, Hearse DJ. The effect of beta blockade and partial agonist activity during myocardial ischemia. Adv Myocardiol. 1983;4:513-20.
34. Magee PG, Gardner TJ, Flaherty JT, Bulkley BH, Goldman RA, Gott VL. Improved myocardial protection with propranolol during induced ischemia. Circulation. 1980;62(2 Pt 2):I49-56.
35. Kawata H, Aoki M, Mayer JE, Jr. Nitroglycerin improves functional recovery of neonatal lamb hearts after 2 hours of cold ischemia. Circulation. 1993;88(5 Pt 2):II366-71.
36. 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.
37. Fazelifar S, Bigdelian H. Effect of esmolol on myocardial protection in pediatrics congenital heart defects. Adv Biomed Res. 2015;4:246.
38. 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.
39. Huang WH, Lee JF, Wang D, Gou WH, Chang CY, Wei J. Postischemia myocardial injury in coronary artery bypass patients (PP6). Transplant Proc. 2010;42(3):725-8.
40. Kim JS, Jeong JH, Moon SJ, Ahn H, Hwang HY. Sufficient myocardial protection of del Nido cardioplegia regardless of ventricular mass and myocardial ischemic time in adult cardiac surgical patients. J Thorac Dis. 2016;8(8):2004-10.
41. Kleinbongard P, Neuhauser M, Thielmann M, Kottenberg E, Peters J, Jakob H, et al. Confounders of Cardioprotection by Remote Ischemic Preconditioning in Patients Undergoing Coronary Artery Bypass Grafting. Cardiology. 2016;133(2):128-33.
42. Mentzer RM, Jr., Birjiniuk V, Khuri S, Lowe JE, Rahko PS, Weisel RD, et al. Adenosine myocardial protection: preliminary results of a phase II clinical trial. Ann Surg. 1999;229(5):643-9; discussion 9-50.
2. Collard CD, Gelman S. Pathophysiology, clinical manifestations, and prevention of ischemia-reperfusion injury. Anesthesiology. 2001;94(6):1133-8.
3. Matata BM, Galinanes M. Cardiopulmonary bypass exacerbates oxidative stress but does not increase proinflammatory cytokine release in patients with diabetes compared with patients without diabetes: regulatory effects of exogenous nitric oxide. J Thorac Cardiovasc Surg. 2000;120(1):1-11.
4. van Boven WJ, Gerritsen WB, Driessen AH, Morshuis WJ, Waanders FG, Haas FJ, et al. Myocardial oxidative stress, and cell injury comparing three different techniques for coronary artery bypass grafting. Eur J Cardiothorac Surg. 2008;34(5):969-75.
5. Kalawski R, Balinski M, Bugajski P, Wysocki H, Olszewski R, Siminiak T. Stimulation of neutrophil activation during coronary artery bypass grafting: comparison of crystalloid and blood cardioplegia. Ann Thorac Surg. 2001;71(3):827-31.
6. Kalawski R, Deskur E, Bugajski P, Wysocki H, Siminiak T. Stimulation of neutrophil integrin expression during coronary artery bypass grafting: comparison of crystalloid and blood cardioplegic solutions. J Thorac Cardiovasc Surg. 2000;119(6):1270-7.
7. Poormoghim H, Moghadam AS, Moradi-Lakeh M, Jafarzadeh M, Asadifar B, Ghelman M, et al. Systemic sclerosis: demographic, clinical and serological features in 100 Iranian patients. Rheumatol Int. 2013;33(8):1943-50.
8. Plicner D, Stolinski J, Rzucidlo-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.
9. Barner H. Historical aspects and current review of myocardial protection. Warm heart surgery Ed Salerno, TA Arnold, London. 1995:1-15.
10. Karmazyn M. Amiloride enhances postischemic ventricular recovery: possible role of Na+-H+ exchange. Am J Physiol. 1988;255(3 Pt 2):H608-15.
11. Hendrikx M, Mubagwa K, Verdonck F, Overloop K, Van Hecke P, Vanstapel F, et al. New Na(+)-H+ exchange inhibitor HOE 694 improves postischemic function and high-energy phosphate resynthesis and reduces Ca2+ overload in isolated perfused rabbit heart. Circulation. 1994;89(6):2787-98.
12. Choy IO, Schepkin VD, Budinger TF, Obayashi DY, Young JN, DeCampli WM. Effects of specific sodium/hydrogen exchange inhibitor during cardioplegic arrest. Ann Thorac Surg. 1997;64(1):94-9.
13. Koike A, Akita T, Hotta Y, Takeya K, Kodama I, Murase M, et al. Protective effects of dimethyl amiloride against postischemic myocardial dysfunction in rabbit hearts: phosphorus 31-nuclear magnetic resonance measurements of intracellular pH and cellular energy. J Thorac Cardiovasc Surg. 1996;112(3):765-75.
14. Cox CS, Jr., Sauer H, Allen SJ, Buja LM, Laine GA. Sodium/hydrogen-exchanger inhibition during cardioplegic arrest and cardiopulmonary bypass: an experimental study. J Thorac Cardiovasc Surg. 2002;123(5):959-66.
15. Castella M, Buckberg GD, Tan Z. Blood cardioplegic protection in profoundly damaged hearts: role of Na+-H+ exchange inhibition during pretreatment or during controlled reperfusion supplementation. Ann Thorac Surg. 2003;75(4):1238-45.
16. Sato T, Sasaki N, O'Rourke B, Marban E. Nicorandil, a potent cardioprotective agent, acts by opening mitochondrial ATP-dependent potassium channels. J Am Coll Cardiol. 2000;35(2):514-8.
17. Steensrud T, Jakobsen O, Ytrehus K, Sorlie DG. Contractile recovery of heart muscle after hypothermic hypoxia is improved by nicorandil via mitochondrial K(ATP) channels. Eur J Cardiothorac Surg. 2006;30(2):256-62.
18. Yamamoto S, Yamada T, Kotake Y, Takeda J. Cardioprotective effects of nicorandil in patients undergoing on-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2008;22(4):548-53.
19. Liu R, Xing J, Miao N, Li W, Liu W, Lai Y-Q, et al. The myocardial protective effect of adenosine as an adjunct to intermittent blood cardioplegia during open heart surgery. European Journal of Cardio-Thoracic Surgery. 2009;36(6):1018-23.
20. Dobson GP, Jones MW. Adenosine and lidocaine: a new concept in nondepolarizing surgical myocardial arrest, protection, and preservation. J Thorac Cardiovasc Surg. 2004;127(3):794-805.
21. Sloots KL, Dobson GP. Normokalemic adenosine-lidocaine cardioplegia: importance of maintaining a polarized myocardium for optimal arrest and reanimation. J Thorac Cardiovasc Surg. 2010;139(6):1576-86.
22. Bessho R, Chambers DJ. Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat. J Thorac Cardiovasc Surg. 2002;124(2):340-51.
23. Fujii M, Chambers DJ. Cardioprotection with esmolol cardioplegia: efficacy as a blood-based solution. European Journal of Cardio-Thoracic Surgery. 2012;43(3):619-27.
24. Braathen B, Jeppsson A, Schersten H, Hagen OM, Vengen O, Rexius H, et al. One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study. J Thorac Cardiovasc Surg. 2011;141(4):995-1001.
25. Sezai A, Wakui S, Akiyama K, Hata M, Yoshitake I, Unosawa S, et al. Myocardial protective effect of human atrial natriuretic Peptide in cardiac surgery. -hANP Shot" in clinical safety trial. Circ J. 2011;75(9):2144-50.
26. Katzung BG. Basic & Clinical Pharmacology: McGraw-Hill Medical; 2006.
27. Tanaka T, Kazui T, Komatsu K, Sasaki A, Inoue N, Izumiyama O, et al. [Effects of blood-diltiazem-nitroglycerin-cardioplegia in coronary artery bypass grafting]. Kyobu Geka. 1992;45(11):964-7.
28. McKeown PP, McClelland JS, Bone DK, Jones EL, Kaplan JA, Lutz JF, et al. Nitroglycerin as an adjunct to hypothermic hyperkalemic cardioplegia. Circulation. 1983;68(3 Pt 2):II107-11.
29. Hearse DJ, O'Brien K, Braimbridge MV. Protection of the myocardium during ischemic arrest. Dose-response curves for procaine and lignocaine in cardioplegic solutions. J Thorac Cardiovasc Surg. 1981;81(6):873-9.
30. Preusse CJ, Gebhard MM, Bretschneider HJ. Myocardial "equilibration processes" and myocardial energy turnover during initiation of artificial cardiac arrest with cardioplegic solution - reasons for a sufficiently long cardioplegic perfusion. Thorac Cardiovasc Surg. 1981;29(2):71-6.
31. Bretschneider HJ. Myocardial protection. Thorac Cardiovasc Surg. 1980;28(5):295-302.
32. Fallah S, Seifi M, Firoozrai M, Godarzi T, Jafarzadeh M, Ghohari L. Influence of Apo E polymorphism on coronary artery disease. World Acad Sci Eng Technol. 2009;57.
33. Manning AS, Keogh JM, Coltart DJ, Hearse DJ. The effect of beta blockade and partial agonist activity during myocardial ischemia. Adv Myocardiol. 1983;4:513-20.
34. Magee PG, Gardner TJ, Flaherty JT, Bulkley BH, Goldman RA, Gott VL. Improved myocardial protection with propranolol during induced ischemia. Circulation. 1980;62(2 Pt 2):I49-56.
35. Kawata H, Aoki M, Mayer JE, Jr. Nitroglycerin improves functional recovery of neonatal lamb hearts after 2 hours of cold ischemia. Circulation. 1993;88(5 Pt 2):II366-71.
36. 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.
37. Fazelifar S, Bigdelian H. Effect of esmolol on myocardial protection in pediatrics congenital heart defects. Adv Biomed Res. 2015;4:246.
38. 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.
39. Huang WH, Lee JF, Wang D, Gou WH, Chang CY, Wei J. Postischemia myocardial injury in coronary artery bypass patients (PP6). Transplant Proc. 2010;42(3):725-8.
40. Kim JS, Jeong JH, Moon SJ, Ahn H, Hwang HY. Sufficient myocardial protection of del Nido cardioplegia regardless of ventricular mass and myocardial ischemic time in adult cardiac surgical patients. J Thorac Dis. 2016;8(8):2004-10.
41. Kleinbongard P, Neuhauser M, Thielmann M, Kottenberg E, Peters J, Jakob H, et al. Confounders of Cardioprotection by Remote Ischemic Preconditioning in Patients Undergoing Coronary Artery Bypass Grafting. Cardiology. 2016;133(2):128-33.
42. Mentzer RM, Jr., Birjiniuk V, Khuri S, Lowe JE, Rahko PS, Weisel RD, et al. Adenosine myocardial protection: preliminary results of a phase II clinical trial. Ann Surg. 1999;229(5):643-9; discussion 9-50.
| Files | ||
| Issue | Vol 57, No 10 (2019) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v57i10.3246 | |
| Keywords | ||
| Coronary artery bypass graft Cardioplegia Trinitroglycerine | ||
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How to Cite
1.
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. 2020;57(10):586-591.
