The Effect of N-acetylcysteine in Prime Solution on Reducing Damage to the Myocardium in Open Heart Surgery

Cardiopulmonary bypass and reperfusion injury lead to the release of free radicals and inflammatory mediators during surgery. The use of antioxidants during cardiopulmonary bypass has become a strategy to save the myocardium from the attack of these radicals. This study aimed to investigate the effect of N-acetyl cysteine on reducing damage to the myocardium caused by free radicals.

In a randomized clinical trial, 40 patients who were candidates for vascular graft surgery to receive N-acetyl cysteine in Prime solution were randomly divided into two intervention and control groups. In the intervention group, N-acetyl cysteine was added to the prime solution, and in the control group, an equivalent volume of placebo (normal saline) was administered. The levels of Troponin I and C-reactive protein, the need for shock and pacemaker, and the length of stay in the Intensive Care Unit were investigated and compared in both groups.

The patients of both groups did not have significant differences in terms of ages, sex, ejection fraction, duration of the pump, and Athort clamp. Average troponin 8 hours after surgery in the intervention and control groups were 60.5 ± 1.84 and 5.05 ± 1.84 respectively. 10.37 ± 1.0 and the average CRP 24 hours after the operation was 28.47 ± 7.45 and 55.18 ± 5.74, respectively. The need for a defibrillator was not significantly different between the two groups (P < 0.05). The average length of stay in the intensive care unit in the intervention and control groups was 51.73 ± 10.9 and 55.78 ± 13.5, respectively, and no significant difference was seen.

The results show that the use of NAC decreases CRP and cTnI after open heart surgery, which shows its antioxidant and anti-inflammatory effect on the myocardium.