Objectives: L-Arginine improves myocardial protection stimulating the release of nitric oxide and the endothelium dependent vasodilatation and thus increasing coronary blood flow, decreasing platelets activation and leukocyte adhesion properties. The aim of our study was to compare the use of L-Arginine in addiction to the cardioplegic solution during CABG. Methods: We prospectively randomized 69 consecutive patients who underwent coronary artery bypass grafting to receive 7,5g of L-Arginine in 500 mL in addiction to the cardioplegic solution. We used a Swan-Ganz catheter to perform hemodynamic evaluations, measuring the cardiac index, systemic vascular resistances, pulmonary vascular resistances and the pulmonary capillary wedge pressure at 3 times: before sternum opening, at sternum closure, and 1 hour after the arrival in intensive care unit. We also considered blood samples taken from the retrograde coronary sinus catheter for lactate, IL-2R, IL-6 and TNF-  level measures before aortic cross clamping, at the unclamping and 15 minutes after. Serum samples from systemic blood vessels at 4 different times (preoperatively, 2, 18 and 42 hours after aortic clamping removal) were also analyzed , in order to measure CPK, CK-MB MASS, cardiac Troponin T, platelets, leukocytes. In all patients we performed a transesophageal echocardiographic study, before aortic cannulation and before protamine sulfate administration to assess the myocardial contractility. Results: The two groups are homogeneous for preoperative characteristics and operatory data. Postoperative data showed a statistical significative difference between groups for IL-6 (p=0,01) and Troponin-T (p=0,01) in advantage for the treated group and decreased levels of CPK (p=0,006), Leukocytes (p=0,023) and Wedge pressure (p=0,007). Moreover ICU stay (p=0,033) was reduced in L- Arginine group. Conclusions: This study shows several positive effects of L-Arginine to our cardioplegic solution. IL-6 and Troponin-T reduction demonstrates a better myocardial preservation with reduced ischemic injury. The decrease of Wedge pressure we observed in group A may be related to a vasodilation effect. The decrease of the leukocytes count in group A postoperatively, might express a reduced ischemia-reperfusion damage.
L-Arginine addiction to cardioplegia: Myocardial and systemic protective effects / Colagrande, L; Formica, F; Porta, F; Martino, A; Sangalli, F; Avalli, L; Paolini, G; Brustia, M. - (2004). (Intervento presentato al convegno XXII Congresso Nazionale della Società Italiana di Chirurgia Cardiaca tenutosi a Bologna nel 2004).
L-Arginine addiction to cardioplegia: Myocardial and systemic protective effects
Formica F;
2004-01-01
Abstract
Objectives: L-Arginine improves myocardial protection stimulating the release of nitric oxide and the endothelium dependent vasodilatation and thus increasing coronary blood flow, decreasing platelets activation and leukocyte adhesion properties. The aim of our study was to compare the use of L-Arginine in addiction to the cardioplegic solution during CABG. Methods: We prospectively randomized 69 consecutive patients who underwent coronary artery bypass grafting to receive 7,5g of L-Arginine in 500 mL in addiction to the cardioplegic solution. We used a Swan-Ganz catheter to perform hemodynamic evaluations, measuring the cardiac index, systemic vascular resistances, pulmonary vascular resistances and the pulmonary capillary wedge pressure at 3 times: before sternum opening, at sternum closure, and 1 hour after the arrival in intensive care unit. We also considered blood samples taken from the retrograde coronary sinus catheter for lactate, IL-2R, IL-6 and TNF-  level measures before aortic cross clamping, at the unclamping and 15 minutes after. Serum samples from systemic blood vessels at 4 different times (preoperatively, 2, 18 and 42 hours after aortic clamping removal) were also analyzed , in order to measure CPK, CK-MB MASS, cardiac Troponin T, platelets, leukocytes. In all patients we performed a transesophageal echocardiographic study, before aortic cannulation and before protamine sulfate administration to assess the myocardial contractility. Results: The two groups are homogeneous for preoperative characteristics and operatory data. Postoperative data showed a statistical significative difference between groups for IL-6 (p=0,01) and Troponin-T (p=0,01) in advantage for the treated group and decreased levels of CPK (p=0,006), Leukocytes (p=0,023) and Wedge pressure (p=0,007). Moreover ICU stay (p=0,033) was reduced in L- Arginine group. Conclusions: This study shows several positive effects of L-Arginine to our cardioplegic solution. IL-6 and Troponin-T reduction demonstrates a better myocardial preservation with reduced ischemic injury. The decrease of Wedge pressure we observed in group A may be related to a vasodilation effect. The decrease of the leukocytes count in group A postoperatively, might express a reduced ischemia-reperfusion damage.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
