CLINICAL AND MOLECULAR ASPECTS OF NITRIC OXIDE THERAPY IN CARDIAC SURGERY: A REVIEW ARTICLE

Highlights

• Despitetheachievements of moderncardiac surgery, the level of postoperativecomplicationsremainshigh,whichunderlines the urgency of searching for newmethods of organprotectionin the perioperativeperiod.
• Ischemicreperfusioninjuriesareoneof the keyfactorsprovoking the development of complicationsaftercardiacsurgery,including those performedusingartificial blood circulation.
• Decreasedbioavailability of endogenousnitricoxide(NO)isoneof the consequences of artificial blood circulation,whichcanleadtoincreaseddamage to organsandtissues.

Abstract

Despite significant advances in cardiac surgery, the incidence of postoperative complications remains high. The use of exogenous nitric oxide (NO) is considered a promising method of perioperative organ protection. Experimental and clinical data indicate that perioperative delivery of NO can modulate ischemia–reperfusion injury, activate cGMP-dependent signaling pathways, and limit oxidative stress and inflammatory responses.

This review presents current data on the cardioprotective, nephroprotective, pulmonoprotective, and anti-infective effects of perioperative NO therapy.

Special attention is given to the molecular mechanisms of nitric oxide action, including regulation of mitochondrial function, modulation of endothelial dysfunction, and its effects on hemostasis and the systemic inflammatory response. The pathophysiological mechanisms underlying reduced endogenous NO bioavailability during cardiopulmonary bypass and the role of its exogenous compensation in promoting an organ-protective phenotype are discussed.

Despite encouraging clinical trial results, important questions remain unresolved regarding optimal dosing regimens, duration of therapy, and risk-based stratification of patients for organ dysfunction.

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