Cardioprotective Effect of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine During Coronary Artery Bypass Grafting

Koramaz, Ismail; Pulathan, Zerrin; Usta, Sefer; Karahan, Süleyman Caner; Alver, Ahmet; Yariş, Ersin; Kalyoncu, Nuri İ̇hsan; Özcan, Fahri

doi:10.1016/j.athoracsur.2005.08.013

Cited by 31 publications

(26 citation statements)

References 23 publications

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“…Sucu et al evaluated myeloperoxidase, malondialdehyde, interleukin‐6, α1‐acid glycoprotein, and C‐reactive protein, and found that NAC decreased oxidoinflammatory response during surgery. Koramaz et al compared cold‐blood cardioplegia enriched with NAC and cold‐blood cardioplegia alone, and found that postoperative troponin I levels were lower and malondialdehyde levels were higher in the control group compared with the NAC group. Vento et al have shown that myocardial glutathione content is better preserved, myeloperoxidase activity is lower, and leukocytes sequestered in the coronary circulation are lower in patients receiving NAC than in the control group .…”

Section: Discussionmentioning

confidence: 99%

Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment

Özaydın

Peker

Erdoğan

et al. 2014

Clinical Cardiology

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Background: Atrial fibrillation is associated with inflammation and oxidative stress. Hypothesis: Carvedilol and N-acetyl cysteine (NAC) combination decreases inflammation, oxidative stress, and postoperative atrial fibrillation (POAF) rates more than metoprolol or carvedilol. Methods: Preoperative and postoperative total oxidative stress (TOS), total antioxidant capacity (TAC), and white blood cells (WBC) were measured in metoprolol, carvedilol, or carvedilol plus NAC groups, and association with POAF was evaluated. Results: Preoperative TAC, TOS, and WBC levels were similar among the groups. Postoperative TAC levels were lower in the metoprolol group compared with the carvedilol group (1.0 vs 1.4) or the carvedilol plus NAC group (1.0 vs 1.9) and were also lower in the carvedilol group compared with the carvedilol plus NAC group (all P < 0.0001). Postoperative TOS levels were higher in the metoprolol group as compared with the carvedilol (29.6 vs 24.2; P < 0.0001) or the carvedilol plus NAC groups (P < 0.0001), and were also higher in the carvedilol group as compared with the carvedilol plus NAC group (24.2 vs 19.3; P < 0.0001). Postoperative WBC counts were lower in the carvedilol plus NAC group compared with the metoprolol group (12.9 vs 14.8; P = 0.004), were similar between the carvedilol and the metoprolol groups (13 vs 14.8) and between the carvedilol plus NAC group and the carvedilol group (both P > 0.05). Postoperative TAC, TOS, and WBC were associated with POAF. Conclusions: Carvedilol plus NAC reduced oxidative stress and inflammation compared with metoprolol and decreased oxidative stress compared with carvedilol. Postoperative TAC, TOS, and WBC were associated with POAF. IntroductionCardiopulmonary bypass may cause oxidative stress and inflammation 1 processes that have been shown to be associated with atrial fibrillation.2 -5 Carvedilol is a nonselective β-blocker and N-acetyl cysteine (NAC) is a mucolytic agent. These agents have anti-inflammatory and antioxidant properties, 6 -16 and they decreased postoperative atrial fibrillation (POAF) rates in previous studies.2,17 -22 In a randomized study, we have shown that carvedilol plus NAC decreased POAF incidence compared with metoprolol or carvedilol.23 However, it is not known whether the effect of carvedilol and NAC is associated with changes in the levels of oxidative markers or whether there is a correlation between these markers and the development of POAF.

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Section: Discussionmentioning

confidence: 99%

Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment

Özaydın

Peker

Erdoğan

et al. 2014

Clinical Cardiology

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“…N-acetylcysteine (NAC), a thiol-containing agent employed to increase the available thiol pool including glutathione, has been increasingly used over the past decade with its main potential being the minimization of the impact of ischemia-reperfusion injury on the heart as an antioxidant agent [13,14] . In a previous study, we reported that the supplementation of cold-blood cardioplegia with NAC may have a beneficial myocardial protective effect in the early period of CABG [15] . Because structural changes in serum albumin may be related to the conditions occurring at ischemia-reperfusion in CABG, determination of IMA may be useful to evaluate the antioxidant effect of NAC on early reperfusion injury observed in CABG.…”

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confidence: 99%

Ischemia-Modified Albumin Reduction after Coronary Bypass Surgery Is Associated with the Cardioprotective Efficacy of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine: A Preliminary Study

Karahan¹,

Koramaz²,

Altun³

et al. 2009

Eur Surg Res

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Background: The aims of this preliminary study were to determine the alteration of serum ischemia-modified albumin (IMA) levels and to investigate whether IMA may be used as an indicator of the cardioprotective efficacy of N-acetylcysteine (NAC) in patients undergoing coronary bypass grafting (CABG). Patients and Methods: Forty-four patients were randomized into one of two groups on the basis of cardioplegic strategies, either cold-blood cardioplegia enriched with NAC (50 mg/kg) or cold-blood cardioplegia alone. Serum IMA, cardiac troponin T (cTnT) and malondialdehyde (MDA) levels determined in NAC-enriched patients before and after CABG were compared with those of the NAC-free group. The albumin cobalt binding assay was used for IMA determination. Results: Serum IMA levels were significantly elevated after cross-clamping and peaked at 6 h after reperfusion in the two groups. In NAC-enriched patients, IMA levels determined 6, 12, 24 and 48 h after reperfusion were significantly lower than those of the NAC-free group (p ≤ 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IMA returned to baseline 24 h after reperfusion differently from cTnT and MDA in the NAC-enriched group. Conclusions: IMA may be used as not only an indicator of myocardial ischemia-reperfusion injury, but also as a useful indicator of the cardioprotective effect of NAC in CABG.

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“…NAC is a free radical scavenger and glutathione precursor. It has been shown to reduce free radical production, oxidative and inflammatory response, and myocardial ischemia/reperfusion injury after bypass surgery. Carvedilol is an antioxidant, anti‐inflammatory, nonselective β‐blocker …”

Section: Discussionmentioning

confidence: 99%

Addition of N‐Acetyl Cysteine to Carvedilol Decreases the Incidence of Acute Renal Injury After Cardiac Surgery

Özaydın

Peker

Akcay

et al. 2013

Clinical Cardiology

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Cardioprotective Effect of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine During Coronary Artery Bypass Grafting

Cited by 31 publications

References 23 publications

Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment

Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment

Ischemia-Modified Albumin Reduction after Coronary Bypass Surgery Is Associated with the Cardioprotective Efficacy of Cold-Blood Cardioplegia Enriched with N-Acetylcysteine: A Preliminary Study

Addition of N‐Acetyl Cysteine to Carvedilol Decreases the Incidence of Acute Renal Injury After Cardiac Surgery

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