Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Influence of the method of gaseous nitric oxide administration on the effectiveness of myocardial protection during operations with cardiopulmonary bypass

Authors: Pichugin V.V., Domnin S.E., Sandalkin E.V., Ryazanov M.V., Bober V.V.

Company:
1 Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
2 Specialized Cardiac Surgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-2-137-146

UDC: 616.12-089.166:616.1-78]-06:616.127-084

Link: Clinical Physiology of Blood Circulaiton. 2022; 2 (19): 137-146

Quote as: Pichugin V.V., Domnin S.E., Sandalkin E.V., Ryazanov M.V., Bober V.V. Influence of the method of gaseous nitric oxide administration on the effectiveness of myocardial protection during operations with cardiopulmonary bypass. Clinical Physiology of Circulation. 2022; 19 (2): 137–46 (in Russ.). DOI: 10.24022/1814-6910-2022-19-2-137-146

Received / Accepted:  07.02.2022 / 09.03.2022

Download
Full text:  

Abstract

Objective. The aim of the study was a comparative assessment of the inhalation and extracorporeal methods of administering gaseous nitric oxide on the effectiveness of myocardial protection during heart valves surgery with cardiopulmonary bypass (CPB).

Material and methods. The study included 93 patients who underwent heart surgery with CPB. Three groups of patients were created: the first (control, 30 patients), the second (30 patients) – nitric oxide was administered by inhalation during the entire operation, the third (33 patients) – nitric oxide was added into the sweep gas of the extracorporeal circuit. The level of troponin I (cTn I) was determined in the postoperative period – after transfer into the ICU, 12, 24 and 48 hours after the operation; studied clinical and functional indicators.

Results. Statistically lower levels of cTn I were revealed after transfer into the ICU, 12, 24 and 48 hours after surgery, a decrease in VIS, a shortening of stay in the ICU and the incidence of acute heart failure in patients of the 2nd and 3rd groups. There were no statistically significant differences between the method of inhalation and extracorporeal administration of nitric oxide.

Conclusions. Gaseous nitric oxide has a clinically pronounced cardioprotective effect and its effectiveness does not depend on the route of administration (inhalation or extracorporeal).

References

  1. Gianetti J., Del Sarto P., Bevilacqua S., Vassalle C., De Filippis R., Kacila M. et al. A. Supplemental nitric oxide and its effect on myocardial injury and function in patients undergoing cardiac surgery with extracorporeal circulation. J. Thorac. Cardiovasc. Surg. 2004; 127: 44–50. DOI: 10.1016/j.jtcvs.2002.08.001
  2. Пичугин В.В., Сейфетдинов И.Р., Рязанов М.В., Домнин С.Е., Медведев А.П., Гамзаев А.Б. Клиническая оценка эффективности фармакологического прекондиционирования миокарда оксидом азота при операциях с искусственным кровообращением. Клиническая физиология кровообращения. 2020; 17 (3): 203–11. DOI: 10.24022/1814-6910-2020-17-3-203-211
  3. Checchia P.A., Bronicki R.A., Muenzer J.T., Dixon D., Raithel S., Gandhi S.K., Huddleston C.B. Nitric oxide delivery during cardiopulmonary bypass reduces postoperative morbidity in children – a randomized trial. J. Thorac. Cardiovasc. Surg. 2013; 146: 530–6. DOI: 10.1016/j.jtcvs.2012.09.100
  4. James Ch., Millar J.C., Horton S., Brizard C.P. Nitric oxide administration during paediatric cardiopulmonary bypass: a randomised controlled trial. Intensive Care Med. 2016; 42: 1744–52. DOI: 10.1007/s00134-016-4420-6
  5. Kamenshchikov N.O., Mandel I.A., Podoksenov Yu.K., Svirko Yu.S., Lomivorotov V.V., Mikheev S.L. et al. Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery: randomized trial. J. Thorac. Cardiovasc. Surg. 2019; 157 (6): 2328–36.e12018. DOI: 10.1016/j.jtcvs.2018.08.117
  6. Баутин А.Е., Селемир В.Д., Нургалиева А.И., Морозов К.А., Никифоров В.Г., Викташева Л.З. и др. Ингаляционная терапия оксидом азота, полученным методом синтеза из атмосферного воздуха, в послеоперационном периоде кардиохирургических вмешательств у детей: одноцентровое ретроспективное когортное исследование. Вестник интенсивной терапии им. А.И. Салтанова. 2021; 3: 98–107. DOI: 10.21320/1818-474X-2021-3-98-107
  7. Пичугин В.В., Мельников Н.Ю., Сандалкин Е.В., Медведев А.П., Гамзаев А.Б., Журко С.А., Чигинев В.А. Защита сердца и легких при анестезиолого-перфузионном обеспечении операций на клапанах сердца. Клиническая физиология кровообращения. 2014; 4: 50–9.
  8. Пичугин В.В., Бобер В.В., Домнин С.Е., Никольский В.О., Богуш А.В., Чигинев В.А. Эффективность методов защиты легких у пациентов с высокой легочной гипертензией при коррекции клапанных пороков сердца. Медицинский альманах. 2017; 3: 130–6.
  9. Пичугин В.В., Сейфетдинов И.Р., Медведев А.П., Домнин С.Е. Ингаляционный оксид азота в профилактике ишемических и реперфузионных повреждений сердца при операциях с искусственным кровообращением. Медицинский альманах. 2019; 1: 81–7.
****
  1. Gianetti J., Del Sarto P., Bevilacqua S., Vassalle C., De Filippis R., Kacila M. et al. A. Supplemental nitric oxide and its effect on myocardial injury and function in patients undergoing cardiac surgery with extracorporeal circulation. J. Thorac. Cardiovasc. Surg. 2004; 127: 44–50. DOI: 10.1016/j.jtcvs.2002.08.001
  2. Pichugin V.V., Seyfetdinov I.R., Ryazanov M.V., Domnin S.E., Medvedev A.P., Gamzaev A.B. A clinical evaluation of the effectiveness of pharmacological preconditioning of the myocardium with nitric oxide in operations with cardiopulmonary bypass. Clinical Physiology of Circulation. 2020; 17 (3): 203–11 (in Russ.). DOI: 10.24022/1814-6910-2020-17-3-203-211
  3. Checchia P.A., Bronicki R.A., Muenzer J.T., Dixon D., Raithel S., Gandhi S.K., Huddleston C.B. Nitric oxide delivery during cardiopulmonary bypass reduces postoperative morbidity in children – a randomized trial. J. Thorac. Cardiovasc. Surg. 2013; 146: 530–6. DOI: 10.1016/j.jtcvs.2012.09.100
  4. James Ch., Millar J.C., Horton S., Brizard C.P. Nitric oxide administration during paediatric cardiopulmonary bypass: a randomised controlled trial. Intensive Care Med. 2016; 42: 1744–52. DOI: 10.1007/s00134-016-4420-6
  5. Kamenshchikov N.O., Mandel I.A., Podoksenov Yu.K., Svirko Yu.S., Lomivorotov V.V., Mikheev S.L. et al. Nitric oxide provides myocardial protection when added to the cardiopulmonary bypass circuit during cardiac surgery: randomized trial. J. Thorac. Cardiovasc. Surg. 2019; 157 (6): 2328–36.e12018. DOI: 10.1016/j.jtcvs.2018.08.117
  6. Bautin A.E., Selemir V.D., Nurgalieva A.I., Morozov K.A., Nikiforov V.G., Viktasheva L.Z. et al. Inhalation therapy with nitric oxide synthesized from atmospheric air in the postoperative period of cardiac surgery in children: a single-center retrospective cohort study. Bulletin of Intensive Care. A.I. Saltanov. 2021; 3: 98–107 (in Russ.). DOI: 10.21320/1818-474X-2021-3-98-107
  7. Pichugin V.V., Mel’nikov N.Yu., Sandalkin E.V., Medvedev A.P., Gamzaev A.B., Zhurko S.A., Chiginev V.A. Heart and lungs protection techniques in anesthetic and perfusion management of heart valves surgery. Clinical Physiology of Circulation. 2014; 4: 50–9 (in Russ.).
  8. Pichugin V.V., Bober V.V., Domnin S.E., Nikolsky V.O., Bogush A.V., Chiginev V.A. The effectiveness of lung protection methods in patients with high pulmonary hypertension in the correction of valvular heart disease. Medical Almanach. 2017; 3: 130–6 (in Russ.).
  9. Pichugin V.V., Seyfetdinov I.R., Medvedev A.P., Domnin S.E. Inhaled nitric oxide in the prevention of ischemic and reperfusion injuries of the heart during operations with cardiopulmonary bypass. Medical Almanach. 2019; 1: 81–7 (in Russ.).

About Authors

  • Vladimir V. Pichugin, Dr. Med. Sci., Professor; ORCID
  • Stepan E. Domnin, Cand. Med. Sci., Anesthesiologist; ORCID
  • Evgeniy V. Sandalkin, Cand. Med. Sci., Associate Professor of Chair of Anesthesiology, Resuscitation and Transfusiology; ORCID
  • Mikhail V. Ryazanov, Cand. Med. Sci., Associate Professor of Chair of Hospital Surgery named after B.A. Korolev; ORCID
  • Valeriya V. Bober, Cand. Med. Sci., Associate Professor of Chair of Anesthesiology, Resuscitation and Transfusiology; ORCID

 If you found mistakes, select text and press Alt+A