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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2002 December;43(6):803-9

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Inhibition of systemic inflammatory response with sodium nitroprusside in open heart surgery

Göl M. K., Nisanoglu V., Iscan Z., Balci M., Kandemir Ö., Tasdemir O.

Cardiovascular Surgery Clinic Türkiye Yüksek İhtisas Hospital Ankara, Turkey


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Back­ground. A ­nitric ­oxide ­donor, ­sodium nitro­prus­side has ­been ­reported to ­reduce the inflam­ma­tory ­response ­during car­di­o­pul­mo­nary ­bypass (CPB). To inves­ti­gate ­this, a ­double-­blind and pros­pec­tive ­study was con­ducted.
­Methods. ­Twenty ­patients ­with ­multi ­vessel cor­o­nary dis­ease ­were ran­domly ­chosen to ­form ­study (SNP) and con­trol ­groups. In the SNP ­group, 0.5 μg/kg/­min ­sodium nitro­prus­side ­were admin­is­tered for 20 min­ ­right ­after the ­release of the ­aortic cross­clamp. Mac-1 (CD11b/CD18) leu­ko­cyte adhe­sion mole­cule expres­sions, inter­leukin-6 ­levels ­were meas­ured ­from ­radial ­artery ­blood as ­well as leu­ko­cyte and ­platelet ­counts in ­both ­groups at 6 dif­ferent ­time ­points: a) ­before anes­thesia, b) ­after hep­arin admin­is­tra­tion, c) ­after ­aortic cross­clamp ­release, d) ­after pro­ta­mine admin­is­tra­tion, e) 3 ­hours ­after the ter­mi­na­tion of CPB, f) 24 ­hours ­after the ter­mi­na­tion of CPB.
­Results. The ­increase in Mac-1 expres­sions ­were not dif­ferent ­between the two ­groups at any ­time ­point ­except the meas­ure­ments ­after the admin­is­tra­tion of pro­ta­mine. At ­this ­time ­point, Mac-1 expres­sions ­were not dif­ferent ­between the ­groups (99.8±30.7 vs 134.6±95.1%, p=0.076), but ­higher ­when com­pared ­with the pre­in­duc­tion ­levels. IL-6 ­levels for SNP and con­trol ­groups was 89±43 and 215±131 pg/dL, respec­tively (p=0.016) 3 ­hours ­after the ter­mi­na­tion of CPB. ­Twenty-­four ­hours ­after the ter­mi­na­tion of CPB, IL-6 ­levels ­were ­still sig­nif­i­cantly ­higher in the con­trol ­group (47±27 vs 111±68 pg/dL, p=0.039). Leu­ko­cyte and ­platelet ­counts ­were not dif­ferent at any ­time ­point ­between the ­groups.
Con­clu­sions. ­Systemic inflam­ma­tory ­response in ­patients under­going CPB can be ­reduced to a cer­tain ­level ­with ­sodium nitro­prus­side, espe­cially the acti­va­tion of vas­cular endo­the­lial ­cells can be inhib­ited, but acti­va­tion of lekoc­ytes ­still ­takes ­place.

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