Potential Protective Effects of Intravenous N-acetylcysteine on Myocardial Ischemia - Reperfusion Injury in Coronary Artery Bypass Graft Surgeries

Abstract

Summary M yocardial ischemia reperfusion injury (IRI) will always be one of the big challenges that we face during cardiopulmonary bypass (CPB) and cardioplegic arrest (CA). It affects both cardiac myocytes and coronary endothelial cells and is considered to be a major factor contributing toperioperative myocardial damage. The massive release of oxygenfree radicals during the early phase of reperfusion is the source of these injuries. Several agents have been used to protect the myocardium and minimize the damage during CPB. N-acetylcysteine (NAC)was among these agents.N-acetylcysteine (NAC) has been used for almost half a century to treat congestive and obstructive lung diseases, and since the mid-1970’s it has also been used to treat paracetamol intoxication. Several recent reports have suggested that its use may be extended to manage clinical conditions as diversified as IRI, inflammation related complications after CPB and renal damage provoked by radiographic contrast. As an extensively used and relatively safe drug, NAC may be a useful adjuvant for the protection of the myocardium in cardiac surgery.