Sodium Hydrosulfide In Cardioplegia Attenuates Ischemia Re-perfusion Injury In Coronary Surgical Patients
Mohamed Alaa1, Mohamed AbdulWahab Al Assal2, Arto Nemlander2.
1Faculty of Medicine, Suez Canal University, Ismailia, Egypt, 2Ministry of Health, PAAM Cardiac Center, Arar, Saudi Arabia.
Objectives: Sodium hydrosulfide (NaHS) has been shown to be a promising cardioprotective agent, but its use as a component of cardioplegia in cardiopulmonary bypass (CPB) remained untested in patients. We investigated the potential cardioprotective effects of NaHS added to St.Thomas cardioplegia solution among our coronary bypass surgical (CABG) patients. Methods: After having signed consents and ethical committees' approval. Twenty-Six adult male patients (n=26, mean Age 54±12 years) underwent elective on-pump CABG surgery. Aortic cross-clamp (AXC) times (65±23 min), followed by re-perfusion with warm blood through the aortic root. Group A (n=13) received 1ml/Kg of NaHS cardioplegia solution, Group B (n=13) did not. Conductance hemodynamic parameters were measured intra-operatively and blood samples were collected at baseline, before and 30 min. after AXC, and after weaning-off CPB. Results: dP/dTmax (Group A 4361±518 mmHg/s, Group B 2625±416 mmHg/s) and dP/dTmin (Group A -3499±532 mmHg/s, Group B -1903±194 mmHg/s) were better preserved in group A post-CPB (p<0.05). Group A patients were able to recover faster and match their pre-CPB heart rates and contractility, than group B counterparts (p<0.05). Serum Troponin I levels were lower in group A patients immediately after AXC release (p=0.05), but their levels were comparable post-CPB. Myocardial ATP content was also lower (p<0.01) among group A patients 30 min. post-CPB, indicating better ability of the myocardium to utilize ATP. Conclusions: The addition of NaHS to conventional cardioplegia solution has a significant cardioprotective effect, which leads to swift hemodynamic recovery with significantly improved systolic, diastolic function and ATP utilization. It is superior to plain cardioplegia in reducing myocardial ischemia re-perfusion injury in adult CABG patients.
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