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The role of N-acetyl cystein for myocardial reperfusion damage protection, in patients who was performed coronary artery bypass surgery

Year 2014, , 138 - 144, 01.05.2014
https://doi.org/10.5505/abantmedj.2014.80774

Abstract

Objective: In this study we researched prevention of ischemic reperfusion damage by adding N-acetyl-cystein to primary cardioplegy solution in patients underwent coronary artery bypass surgery with cardiopulmonary bypass. Method: In this study, 60 patients 43 male, 17 female were enrolled who were performed coronary artery bypass surgery with cardiopulmonary bypass at vascular sugery clinic. Consecutively patients divided as 30 patients for study and 30 patients for control groups. 300 mg N-acetyl cystein added to study group’s cardioplegy solution. Myocardial damage markers CK-MB, troponin were obtained from patients pre and postoperatively. Patients followed for postoperative inotrpe need and developing arytmia. Results: There was no statistical significance in comparison of demografic datas, preoperative accompanying risc factors, left ventricule ejection fraction, hemoglobine levels of patients’ of the study. Comparing 24th and 48th hour plasma CK-MB levels and 6th, 12th, 24th and 48th hours troponine levels, study group’s levels were lower than control group.This difference was stastisticaly significant. Postoperative inotropic support need and incidance of aritmia was was lower in the study group, and this was statisticaly significant. Conclusion: Reperfusion damage decreases in patients who underwent coronary artery bypass surgery with cardiopulmonary bypass by adding 300 mg N-acetyl cystein. Further research is needed for detecting most effective procedure about myocardial protection.

References

  • 1. Duran E. Dünyada Kalp Damar Cerrahisinin Tarihçesi. In: Duran E, eds. Kalp ve Damar Cerrahisi. İstanbul: Çapa Tıp Kitabevi, Cilt I, 2004;1:3-12.
  • 2. Buckberg GD, Brazier JR, Nelson RL. Studies of the effects of hypotermia on regional myocardial flow and metabolism during cardiopulmonary bypass. The adequately perfused beating, fibrilating and arrested heart. J Thorac Cardiovas Surg. 1977;73:87-94.
  • 3. Akgün S. Erişkin Kalp Cerrahisinde Miyokard Korunması. In: Duran E, eds. Kalp ve Damar Cerrahisi. İstanbul: Çapa Tıp Kitabevi, Cilt II, 2004;1:1091-106.
  • 4. Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocardial antioxidants in ischemiareperfusion injury. Cardivasc Res. 2000;47:446- 56.
  • 5. Moukarbel GV, Ayoub CM, Abchee AB. Pharmacological therapy for myocardial reperfusion injury. Current Opinion in Pharmacology. 2004;4:147-53.
  • 6. Sochman J, Kolc J, Vrana M, Fabian J. Cardioprotective effects of Nacetylcysteine: the reduction in the extent of infarction and occurrence of reperfusion arrhythmias in the dog. Int J Cardiol 1990;28(2):191-96.
  • 7. Sochman J, Peregrin JH. Total recovery of left ventricular function after acute myocardial infarction: comprehensive therapy with streptokinase, Nacetylcysteine and percutaneous transluminal coronary angioplasty. Int J Cardiol 1992;35:116-18.
  • 8. Sochman J, Vrbska J, Musilova B, Rocek M. Infarct size limitation: acute Nacetylcysteine defense (ISLAND trial): preliminary analysis and report after the first 30 patients. Clin Cardiol 1996;19:94-100.
  • 9. Andersen LW, Thiis J, Kharazmi A, Rygg I. The role of N-acetylcysteine administration on the oxidative response of neutrophils during cardiopulmonary bypass. Perfusion 1995;10(1):21- 26.
  • 10. Kretzschmar M, Klein U, Palutke M, Schirrmeister W. Reduction of ischemiareperfusion syndrome after abdominal aortic aneurysmectomy by Nacetylcysteine but not mannitol. Acta Anaesthesiol Scand 1996;40(6):657- 64.
  • 11. Ceconi C, Curello S, Cargnoni A, Ferrari R, Albertini A, Visioli O. The role of glutathione status in the protection against ischaemic and reperfusion damage: effects of N-acetyl cysteine. J Mol Cell Cardiol 1988;20(1):5-13.
  • 12. Tossios P, Bloch W, Huebner A, Raji MR, Dodos F, Klass O, Suedkamp M, Kasper SM, Hellmich M, Mehlhorn U. N-acetylcysteine prevents reactive oxygen species–mediated myocardial stress in patients undergoing cardiac surgery: results of a randomized, doubleblind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg. 2003;126(5):1513-20.
  • 13. Dikmengil M, Atik U, Oral U. Nacetylcysteine for preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass. Surg Today. 2004;34(3):237-42.
  • 14. Fischer UM, Tossios P, Huebner A, Geissler HJ, Bloch W, Mehlhorn U. Myocardial apoptosis prevention by radical scavenging in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2004;128(1):103-08.
  • 15. Vento AE, Nemlander A, Aittomaki J, Salo J, Karhunen J, Ramo OJ. Nacetylcysteine as an additive to crystalloid cardioplegia increased oxidative stress capacity in CABG patients. Scand Cardiovasc J 2003;37(6):349-55.
  • 16. Koramaz I, Pulathan Z, Usta S, Karahan SC, Alver A, Yaris E, Kalyoncu NI, Ozcan F. Cardioprotective effect of cold-blood cardioplegia enriched with Nacetylcysteine during coronary artery bypass grafting. Ann Thorac Surg 2006;81(2):613-18.
  • 17. Palmer BS, Klawitter PF, Reiser PJ, Angelos MG. Degradation of rat cardiac troponin I during ischemia independent of reperfusion. Am J Physiol Heart Circ Physiol 2004;287(3):1269-75.
  • 18. Orhan G, Yapici N, Yuksel M, Sargin M, Senay S, Yalcin AS, Aykac Z, Aka SA. Effects of Nacetylcysteine on myocardial ischemiareperfusion injury in bypass surgery. Heart Vessels 2006;21(1):42-47.

Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü

Year 2014, , 138 - 144, 01.05.2014
https://doi.org/10.5505/abantmedj.2014.80774

Abstract

AMAÇ: Bu çalışmada kardiyopulmoner bypass ile koroner arter bypass cerrahisi yapılan hastalarda gelişen iskemi reperfüzyon hasarının başlangıç kardiyopleji solüsyonuna eklenen N-asetil sistein ile önlenmesi araştırıldı.YÖNTEMLER: Bu çalışma damar cerrahisi kliniğinde kardiyopulmoner bypass eşliğinde elektif koroner arter bypass cerrahisi yapılan 60 hasta 43 erkek, 17 kadın dahil edildi. Ek kardiyak cerrahi girişim planlanan hastalar, sol ventrikül ejeksiyon fraksiyonu < 30 olan hastalar, acil vakalar, karaciğer ve renal fonksiyon bozukluğu olan, 80 yaş ve üzeri hastalar çalışmaya alınmadı. Ardışık olarak hastalar 30’u kontrol, 30’u çalışma grubu olarak ayrıldı. Çalışma grubuna kardiyopleji solüsyonuna 300 mg N-asetil sistein eklendi. Hastalardan preoperatif, postoperatif kan örnekleri alınarak myokardiyal hasar belirteçleri CK-MB, troponin çalışıldı. Hastalar postoperatif inotrop ihtiyacı ve aritmi gelişimi yönünden izlendi.BULGULAR: Çalışmaya alınan hastaların demografik verileri, preoperatif eşlik eden risk faktörleri, sol ventrikül ejeksiyon fraksiyonu, hemoglobin değerleri açısından istatistiksel anlamlı farklılık yoktu. Çalışma grubu ile kontrol grubu kıyaslandığında miyokardiyal hasar belirteçlerinden Çalışmaya alınan hastaların demografik verileri, preoperatif eşlik eden risk faktörleri, sol ventrikül ejeksiyon fraksiyonu, hemoglobin değerleri açısından istatistiksel anlamlı farklılık yoktu. Çalışma grubu ile kontrol grubu kıyaslandığında miyokardiyal hasar belirteçlerinden CK-MB düzeyleri 24. ve 48. saatlerde, troponin düzeyleri ise 6. 12. 24. ve 48. saatlerde istatistiksel olarak düşük bulundu. Postoperatif inotropik destek ihtiyacı ve aritmi görülme sıklığı çalışma grubunda istatistiksel olarak anlamlı olmak üzere daha az bulundu.SONUÇ: Kardiyopulmoner bypass eşliğinde koroner arter bypass cerrahisi yapılan hastalarda kardiyopleji solüsyonlarına 300 mg N-asetil sistein eklenmesi ile reperfüzyon hasarı oluşumu azaltılmaktadır. Miyokardiyal korunma yöntemleri hakkında en etkin yöntemin saptanması için geniş çapta daha fazla çalışmaya ihtiyaç vardır.

References

  • 1. Duran E. Dünyada Kalp Damar Cerrahisinin Tarihçesi. In: Duran E, eds. Kalp ve Damar Cerrahisi. İstanbul: Çapa Tıp Kitabevi, Cilt I, 2004;1:3-12.
  • 2. Buckberg GD, Brazier JR, Nelson RL. Studies of the effects of hypotermia on regional myocardial flow and metabolism during cardiopulmonary bypass. The adequately perfused beating, fibrilating and arrested heart. J Thorac Cardiovas Surg. 1977;73:87-94.
  • 3. Akgün S. Erişkin Kalp Cerrahisinde Miyokard Korunması. In: Duran E, eds. Kalp ve Damar Cerrahisi. İstanbul: Çapa Tıp Kitabevi, Cilt II, 2004;1:1091-106.
  • 4. Dhalla NS, Elmoselhi AB, Hata T, Makino N. Status of myocardial antioxidants in ischemiareperfusion injury. Cardivasc Res. 2000;47:446- 56.
  • 5. Moukarbel GV, Ayoub CM, Abchee AB. Pharmacological therapy for myocardial reperfusion injury. Current Opinion in Pharmacology. 2004;4:147-53.
  • 6. Sochman J, Kolc J, Vrana M, Fabian J. Cardioprotective effects of Nacetylcysteine: the reduction in the extent of infarction and occurrence of reperfusion arrhythmias in the dog. Int J Cardiol 1990;28(2):191-96.
  • 7. Sochman J, Peregrin JH. Total recovery of left ventricular function after acute myocardial infarction: comprehensive therapy with streptokinase, Nacetylcysteine and percutaneous transluminal coronary angioplasty. Int J Cardiol 1992;35:116-18.
  • 8. Sochman J, Vrbska J, Musilova B, Rocek M. Infarct size limitation: acute Nacetylcysteine defense (ISLAND trial): preliminary analysis and report after the first 30 patients. Clin Cardiol 1996;19:94-100.
  • 9. Andersen LW, Thiis J, Kharazmi A, Rygg I. The role of N-acetylcysteine administration on the oxidative response of neutrophils during cardiopulmonary bypass. Perfusion 1995;10(1):21- 26.
  • 10. Kretzschmar M, Klein U, Palutke M, Schirrmeister W. Reduction of ischemiareperfusion syndrome after abdominal aortic aneurysmectomy by Nacetylcysteine but not mannitol. Acta Anaesthesiol Scand 1996;40(6):657- 64.
  • 11. Ceconi C, Curello S, Cargnoni A, Ferrari R, Albertini A, Visioli O. The role of glutathione status in the protection against ischaemic and reperfusion damage: effects of N-acetyl cysteine. J Mol Cell Cardiol 1988;20(1):5-13.
  • 12. Tossios P, Bloch W, Huebner A, Raji MR, Dodos F, Klass O, Suedkamp M, Kasper SM, Hellmich M, Mehlhorn U. N-acetylcysteine prevents reactive oxygen species–mediated myocardial stress in patients undergoing cardiac surgery: results of a randomized, doubleblind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg. 2003;126(5):1513-20.
  • 13. Dikmengil M, Atik U, Oral U. Nacetylcysteine for preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass. Surg Today. 2004;34(3):237-42.
  • 14. Fischer UM, Tossios P, Huebner A, Geissler HJ, Bloch W, Mehlhorn U. Myocardial apoptosis prevention by radical scavenging in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2004;128(1):103-08.
  • 15. Vento AE, Nemlander A, Aittomaki J, Salo J, Karhunen J, Ramo OJ. Nacetylcysteine as an additive to crystalloid cardioplegia increased oxidative stress capacity in CABG patients. Scand Cardiovasc J 2003;37(6):349-55.
  • 16. Koramaz I, Pulathan Z, Usta S, Karahan SC, Alver A, Yaris E, Kalyoncu NI, Ozcan F. Cardioprotective effect of cold-blood cardioplegia enriched with Nacetylcysteine during coronary artery bypass grafting. Ann Thorac Surg 2006;81(2):613-18.
  • 17. Palmer BS, Klawitter PF, Reiser PJ, Angelos MG. Degradation of rat cardiac troponin I during ischemia independent of reperfusion. Am J Physiol Heart Circ Physiol 2004;287(3):1269-75.
  • 18. Orhan G, Yapici N, Yuksel M, Sargin M, Senay S, Yalcin AS, Aykac Z, Aka SA. Effects of Nacetylcysteine on myocardial ischemiareperfusion injury in bypass surgery. Heart Vessels 2006;21(1):42-47.
There are 18 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Okan Özocak This is me

Orhan Bozoğlan This is me

Faruk Serhatlıoğlu This is me

Bülent Meşe This is me

Kemalettin Erdem This is me

Cemal Kahraman This is me

Publication Date May 1, 2014
Published in Issue Year 2014

Cite

APA Özocak, O., Bozoğlan, O., Serhatlıoğlu, F., Meşe, B., et al. (2014). Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü. Abant Medical Journal, 3(2), 138-144. https://doi.org/10.5505/abantmedj.2014.80774
AMA Özocak O, Bozoğlan O, Serhatlıoğlu F, Meşe B, Erdem K, Kahraman C. Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü. Abant Med J. May 2014;3(2):138-144. doi:10.5505/abantmedj.2014.80774
Chicago Özocak, Okan, Orhan Bozoğlan, Faruk Serhatlıoğlu, Bülent Meşe, Kemalettin Erdem, and Cemal Kahraman. “Koroner Arter Bypass Cerrahisi Uygulanan Hastalarda N-Asetil Sisteinin Miyokardiyal reperfüzyon hasarını önlemedeki Rolü”. Abant Medical Journal 3, no. 2 (May 2014): 138-44. https://doi.org/10.5505/abantmedj.2014.80774.
EndNote Özocak O, Bozoğlan O, Serhatlıoğlu F, Meşe B, Erdem K, Kahraman C (May 1, 2014) Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü. Abant Medical Journal 3 2 138–144.
IEEE O. Özocak, O. Bozoğlan, F. Serhatlıoğlu, B. Meşe, K. Erdem, and C. Kahraman, “Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü”, Abant Med J, vol. 3, no. 2, pp. 138–144, 2014, doi: 10.5505/abantmedj.2014.80774.
ISNAD Özocak, Okan et al. “Koroner Arter Bypass Cerrahisi Uygulanan Hastalarda N-Asetil Sisteinin Miyokardiyal reperfüzyon hasarını önlemedeki Rolü”. Abant Medical Journal 3/2 (May 2014), 138-144. https://doi.org/10.5505/abantmedj.2014.80774.
JAMA Özocak O, Bozoğlan O, Serhatlıoğlu F, Meşe B, Erdem K, Kahraman C. Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü. Abant Med J. 2014;3:138–144.
MLA Özocak, Okan et al. “Koroner Arter Bypass Cerrahisi Uygulanan Hastalarda N-Asetil Sisteinin Miyokardiyal reperfüzyon hasarını önlemedeki Rolü”. Abant Medical Journal, vol. 3, no. 2, 2014, pp. 138-44, doi:10.5505/abantmedj.2014.80774.
Vancouver Özocak O, Bozoğlan O, Serhatlıoğlu F, Meşe B, Erdem K, Kahraman C. Koroner arter bypass cerrahisi uygulanan hastalarda n-asetil sisteinin miyokardiyal reperfüzyon hasarını önlemedeki rolü. Abant Med J. 2014;3(2):138-44.