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Eur J Cardiothorac Surg 2000;18:342-347
© 2000 Elsevier Science NL

Role of nitric oxide in a temperature dependent regulation of systemic vascular resistance in cardiopulmonary bypass

^a First Department of Surgery, Osaka University Medical School, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
^b Division of Cardiovascular Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan

Received 4 February 2000; received in revised form 7 April 2000; accepted 12 April 2000.

Corresponding author. Tel.: +81-6-6771-6051; fax: +81-6-6775-2889
e-mail: tohata{at}aol.com

Objectives: Nitric oxide is the most potent vasodilator among inflammation-mediated vasoactive substances. Tepid cardiopulmonary bypass has been known to maintain low vascular resistance and nitric oxide may also be involved. There has been no previous clinical study elucidating a role of nitric oxide in a temperature dependent regulation of systemic vascular resistance in cardiopulmonary bypass. Methods: Thirty-one patients who underwent valvular surgery were randomly divided into two comparable groups; consisting of the hypothermic cardiopulmonary bypass (28°C:14 patients) and the tepid cardiopulmonary bypass group (34°C:17 patients). The serum levels of nitric oxide (NO₂^-+NO₃^-), prostaglandin E₂, bradykinin, 6-keto PGF1, thromboxane B₂, endothelin-1, systemic vascular resistance index were measured before, 0, 12 and 24 h after cardiopulmonary bypass. Results: The pattern of change in systemic vascular resistance index and nitric oxide during and after cardiopulmonary bypass were significantly different between the two groups (P=0.0008, P=0.02). The tepid group showed significantly lower levels of systemic vascular resistance index after cardiopulmonary bypass than the hypothermic group (0 h: 2278±735 vs. 4387±1289, 12 h: 1827±817 vs. 2817±1146 and 24 h: 1690±548 vs. 2761±641 dyne s cm^-5 m², P=0.0001, P=0.03, P=0.0006). The nitric oxide levels were significantly higher at 0, 12 and 24 h after cardiopulmonary bypass in the tepid group than those in the hypothermic group (84.7±33.3 vs. 46.3±18.1, 69.8±31.1 vs. 40.1±17.5 and 80.1±38.5 vs. 39.1±15.6 µmol/l, P=0.008, P=0.03, P=0.01). The prostaglandin E₂ levels in the tepid group was significantly higher just after cardiopulmonary bypass than that in the hypothermic group (37.3±20.0 vs. 15.8±8.6 pg/ml, P=0.02). The bradykinin level in the hypothermic group was significantly higher just after cardiopulmonary bypass than that in the tepid group (2.40±0.32 vs. 1.85±0.21 log₁₀ (pg/ml), P=0.005). Only nitric oxide showed a significant negative correlation with the systemic vascular resistance index both during and after cardiopulmonary bypass (r=-0.60, P<0.0001) as compared with prostaglandin E₂ and bradykinin. Conclusions: These findings demonstrated that serum nitric oxide levels in tepid cardiopulmonary bypass were significantly higher than those in hypothermic cardiopulmonary bypass. Nitric oxide correlated with systemic vascular resistance. Thus, nitric oxide may play a pivotal role in a temperature dependent regulation of systemic vascular resistance in cardiopulmonary bypass.

Key Words: Endothelium-derived relaxation factors • Cardiopulmonary bypass • Vasoconstriction

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