Heart Valve Diseases Clinical Trial
Official title:
Prevention of Renal Failure by Nitric Oxide in Prolonged Cardiopulmonary Bypass: A Double Blind Randomized Controlled Trial.
Prolonged periods of cardiopulmonary bypass (CPB) cause high levels of plasma free haemoglobin(Hb) and are associated with increased morbidity. We hypothesized that repletion of nitric oxide (NO) during and after the surgical procedure on CPB may protect against endothelium dysfunction and organ failure caused by plasma-Hb induced NO scavenging.
Prolonged periods of cardiopulmonary bypass (CPB) cause high levels of plasma free
haemoglobin(Hb) and are associated with increased morbidity. We hypothesized that repletion
of nitric oxide (NO) during and after the surgical procedure on CPB may protect against
endothelium dysfunction and organ failure caused by plasma-Hb induced NO scavenging. There
are three possible beneficial mechanisms of delivering NO:
1. Nitric oxide reduces ischemia-reperfusion injury (such as in acute myocardial
infarction, stroke, and acute tubular necrosis).
2. Nitric oxide has anti-inflammatory properties. As antioxidants, exogenous NO may reduce
injury by counteracting the cytotoxic effects of reactive oxygen species, modulating
leukocyte recruitment, edema formation and tissue disruption.
3. Exogenous nitric oxide prevents noxious effects of hemolysis-associated NO
dysregulation. During hemolysis, nitric oxide gas oxidized of plasma oxyhemoglobin to
methemoglobin, thereby inhibiting endogenous endothelium NO scavenging by cell-free Hb.
NO depletion during hemolysis and its sequelae. The release of plasma free Hb (with Fe2+
iron) by hemolysis avidly scavenges nitric oxide (NO) by the dioxygenation reaction. Elevated
plasma ferrous Hb levels can induce a "NO deficiency" state. Reduced vascular nitric oxide
levels can contribute to vasoconstriction, inflammation, and thrombosis, potentially
contributing to systemic endothelial dysfunction after cardiac surgery with CPB.
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