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The effects of low dose N-acetylcysteine (NAC) as an adjunct to cardioplegia in coronary artery bypass surgery [Anatol J Cardiol]
Anatol J Cardiol. 2008; 8(6): 437-443

The effects of low dose N-acetylcysteine (NAC) as an adjunct to cardioplegia in coronary artery bypass surgery

Hakan Köksal1, Ali Rahman2, Oktay Burma5, İhsan Halifeoğlu3, Mustafa Kemal Bayar4
1Clinic of Cardiovascular Surgery, Sivas Numune Hospital, Sivas
2Departments of Cardiovascular Surgery, Faculty of Medicine, Fırat University, Elazığ
3Biochemistry, Faculty of Medicine, Fırat University, Elazığ
4Anesthesiology and Reanimation, Faculty of Medicine, Fırat University, Elazığ
5Department of Cardiovascular Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey

Objective: We aimed to evaluate the efficacy of low dose N-acetylcysteine (NAC) against myocardial ischemia-reperfusion damage in coronary artery bypass surgery accompanied by cardiopulmonary bypass (CPB).
Methods: Thirty patients operated due to triple coronary artery disease were enrolled into this prospective randomized study (control groupn= 15 and NAC group - n=15). N-acetylcysteine was added to induction cardioplegia solution in dose of 4 mmol/l and in dose of 2 mmol/l to maintenance cardioplegia solution in the NAC group. Hemodynamic measurements were performed before and after anesthesia with different intervals. Creatine kinase-MB (CK-MB) levels were analyzed during 24 hours postoperatively. Blood samples were obtained from coronary sinus before CPB (T1), just before the cross-clamp removed (T2) and 30 minutes later (T3). Malondialdehyde (MDA), glutathione peroxidase (GSH-Px), nitric oxide (NO) levels and neutrophil percentage were determined. Statistical analysis was performed using student’s t test, Chi-square and two-way ANOVA tests.
Results: There were no significant differences between the two groups with regard to the hemodynamic parameters, and CK-MB levels. The MDA levels were significantly lower in NAC group than in control group during reperfusion period (0.75 nmol/l vs 0.88 nmol/l, p<0.05). Neutrophil percentage in coronary sinus blood was significantly lower in NAC group than in control group during the reperfusion period (77.6% vs 82.7%, p<0.05). The GSH-Px and NO levels were also not statistically different between groups.
Conclusion: Low dose NAC as an adjunct to cardioplegic solutions effectively reduces myocardial oxidative stress in coronary bypass surgery with cardiopulmonary bypass, but may not restore the myocardial injury. (Anadolu Kardiyol Derg 2008; 8: 437-43)

Keywords: N-acetylcysteine, coronary artery bypass surgery, ischemia-reperfusion, cardioplegia


Hakan Köksal, Ali Rahman, Oktay Burma, İhsan Halifeoğlu, Mustafa Kemal Bayar. The effects of low dose N-acetylcysteine (NAC) as an adjunct to cardioplegia in coronary artery bypass surgery. Anatol J Cardiol. 2008; 8(6): 437-443

Corresponding Author: Hakan Köksal, Türkiye


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