title: Supplemental nitric oxide and its effect on myocardial injury and function in patients undergoing cardiac surgery with extracorporeal circulation.
abstract: BACKGROUND
  Cardiopulmonary bypass induces a systemic inflammatory response that may contribute to clinical morbidity. Gaseous nitric oxide at relatively low concentrations may elicit peripheral anti-inflammatory effects in addition to a reduction of pulmonary resistances. We examined the effects of 20 ppm of inhaled nitric oxide administered for 8 hours during and after cardiopulmonary bypass.
  
  
  RESULTS
  Twenty-nine consecutive patients undergoing aortic valve replacement combined with aortocoronary bypass were randomly allocated to either 20 ppm of inhaled nitric oxide (n = 14) or no additional inhalatory treatment (n = 15). Blood samples for total creatine kinase, creatine kinase MB fraction, and troponin I measurements were collected at 4, 12, 24, and 48 hours postsurgery. In addition, we collected perioperative blood samples for measurements of circulating nitric oxide by-products and brain natriuretic peptide. Soluble P-selectin was analyzed in blood samples withdrawn from the coronary sinus before and after aortic clamping. The area under the curve of creatine kinase MB fraction (P =.03), total creatine kinase (P =.04), and troponin I (P =.04) levels were significantly decreased in the nitric oxide-treated patients. Moreover, in the same group we observed blunted P-selectin and brain natriuretic peptide release (P =.01 and P =.02, respectively). Nitric oxide inhalation consistently enhanced nitric oxide metabolite levels (P =.01).
  
  
  CONCLUSIONS
  Nitric oxide, when administered as a gas at low concentration, is able to blunt the release of markers of myocardial injury and to antagonize the left ventricular subclinical dysfunction during and immediately after cardiopulmonary bypass. The organ protection could be mediated, at least in part, by its anti-inflammatory properties.
authors.affiliation: CNR Institute of Clinical Physiology, G. Pasquinucci Hospital, Massa, Italy. gianetti@ifc.cnr.it
authors.forename: Jacopo
authors.initials: J
authors.lastname: Gianetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Sarto
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Cristina
authors.initials: C
authors.lastname: Vassalle
authors.forename: Rossella
authors.initials: R
authors.lastname: De Filippis
authors.forename: Mirsad
authors.initials: M
authors.lastname: Kacila
authors.forename: Pier Andrea
authors.initials: PA
authors.lastname: Farneti
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Andrea
authors.initials: A
authors.lastname: Biagini
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009569:Nitric Oxide / Q000008:administration & dosage*; D011184:Postoperative Period; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
chemical_list: D009569:Nitric Oxide