Beneficial effect of the addition of nitroglycerin to the cardioplegic solution on lipid peroxidation during coronary artery bypass surgery.

The effects of the addition of a nitric oxide (NO) donor to the cardioplegic solution on reperfusion injury and lipid peroxidation (LPO) in coronary artery bypass grafting (CABG) are not known. Therefore, this work was conducted to determine the possible effects of nitroglycerin on LPO and reperfusion injury as a result of CABG. A prospective double-blind, placebo-controlled study was conducted in 30 consecutive patients with coronary artery disease who underwent CABG with cardiopulmonary bypass. The patients were randomly assigned to receive 3 microg/kg of nitroglycerin added to the cardioplegic solution (NTG group) or 3 microg/kg of placebo added to the cardioplegic solution (placebo group). MDA increased significantly in the placebo group compared to the NTG group during the ischemic (P < 0.01) and reperfusion periods (P < 0.01). The level of troponin I decreased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.001). The level of NO increased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.01). LPO was increased in response to CPB during CABG, together with simultaneous decreases in serum nitric oxide levels, whereas LPO was significantly decreased in response to CPB with nitroglycerin, together with simultaneous increases in the levels of serum nitric oxide.