Objective: L-Arginine in addiction to cardioplegia solution stimulates the release of nitric oxide (NO) and increase coronary blood flow, decreasing platelets activation and leukocyte adhesion. The aim of our study was to determine the feasibility and the efficiency of the addiction of L-Arginine to antegrade and retrograde blood cardioplegia somministrated according to Buckberg protocol. Methods: 28 consecutive patients who underwent coronary artery bypass grafting were randomized to receive 7.5g of L-Arginine in 500 mL in cardioplegic solution. Haemodynamic evaluations were performed before sternum opening, at sternum closure, and 1 hour after the arrival in intensive care unit to measure cardiac index (CI), systemic vascular resistances (RVSI), pulmonary vascular resistances (RVPI) and pulmonary capillary wedge pressure (WP). Blood samples were taken from the retrograde coronary sinus catheter for lactate, IL-2 receptor, Il-6 and TNF levels. Serum samples (preoperatively, 2, 18 and 42 hours after aortic clamping removal) were also analyzed to measure CPK, CK-MB MASS, cardiac Troponin T, platelets (PLT). Leukocytes (LEUCO).Transesophageal echocardiography was performed to assess myocardial contractility. Results: We found statistical differences for RVSI, WP, IL-2 R, Il-6, TNF, PLT, LEUCO in advantage for the treated group, and decreasing trends in CK-MB MASS and Troponin T measures. Conclusions: The present study shows the positive effects of the addiction of L- Arginine to the cardioplegic solution. Reducted Il-2 R, Il-6 and TNF indicate a decrease in myocardial stress. The lower values of RVSI and WP we observed in treated group postoperatively seems to improve the patient’s outcome in terms of a reduced needs of inotropic drugs. Moreover the decrease of PLT consumption and of the LEUCO count we found in treated group might express a reduced no-reflow phenomenon and a decrease in inflammatory reaction, limiting the endothelial injury caused by oxygen radical production.
L-ARGININE AND CARDIOPLEGIA: A PROSPECTIVE RANDOMIZED STUDY / Colagrande, L; Formica, F; Porta, F; Brustia, M; Avalli, L; Sangalli, F; Paolini, G. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - (2006), pp. s21-s21.
L-ARGININE AND CARDIOPLEGIA: A PROSPECTIVE RANDOMIZED STUDY
Formica F;
2006-01-01
Abstract
Objective: L-Arginine in addiction to cardioplegia solution stimulates the release of nitric oxide (NO) and increase coronary blood flow, decreasing platelets activation and leukocyte adhesion. The aim of our study was to determine the feasibility and the efficiency of the addiction of L-Arginine to antegrade and retrograde blood cardioplegia somministrated according to Buckberg protocol. Methods: 28 consecutive patients who underwent coronary artery bypass grafting were randomized to receive 7.5g of L-Arginine in 500 mL in cardioplegic solution. Haemodynamic evaluations were performed before sternum opening, at sternum closure, and 1 hour after the arrival in intensive care unit to measure cardiac index (CI), systemic vascular resistances (RVSI), pulmonary vascular resistances (RVPI) and pulmonary capillary wedge pressure (WP). Blood samples were taken from the retrograde coronary sinus catheter for lactate, IL-2 receptor, Il-6 and TNF levels. Serum samples (preoperatively, 2, 18 and 42 hours after aortic clamping removal) were also analyzed to measure CPK, CK-MB MASS, cardiac Troponin T, platelets (PLT). Leukocytes (LEUCO).Transesophageal echocardiography was performed to assess myocardial contractility. Results: We found statistical differences for RVSI, WP, IL-2 R, Il-6, TNF, PLT, LEUCO in advantage for the treated group, and decreasing trends in CK-MB MASS and Troponin T measures. Conclusions: The present study shows the positive effects of the addiction of L- Arginine to the cardioplegic solution. Reducted Il-2 R, Il-6 and TNF indicate a decrease in myocardial stress. The lower values of RVSI and WP we observed in treated group postoperatively seems to improve the patient’s outcome in terms of a reduced needs of inotropic drugs. Moreover the decrease of PLT consumption and of the LEUCO count we found in treated group might express a reduced no-reflow phenomenon and a decrease in inflammatory reaction, limiting the endothelial injury caused by oxygen radical production.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
