The corrective effect of nitric oxide and molecular hydrogen on parameters of myocardial and endothelial dysfunction in the prevention of multiple organ failure in cardiac surgery patients

Background. Cardiac surgery and cardiopulmonary bypass (CPB) cause ischemia-reperfusion injury, leading to endothelial dysfunction, systemic inflammation and, in some cases, multiple organ failure (MOF), which worsens the prognosis.

Aim. To study the effect of nitric oxide (NO) and molecular hydrogen (H₂) on endothelial dysfunction, myocardial contractility during surgery, and postoperative multiple organ failure.

Materials and methods. The study included 123 patients randomized into 4 groups: 1^st (n = 30) – control; 2^nd (n = 33) – isolated supply of NO (40 ppm) in the CPB circuit; 3^rd (n = 30) – isolated supply of H2 (2 vol%) into the CPB circuit; 4th (n = 30) – combined supply of NO (40 ppm) and H₂ (2 vol%) into the CPB circuit. During surgery, the functional parameters of the heart were studied using transesophageal echocardiography; the state of endothelial cells – by analysis of circulating endothelial cells (CECs); after surgery – biochemical blood parameters and clinical outcomes.

Results. The action of NO and H₂ improved the contractile function of the myocardium, reduced the increase in AST and ALT activity, reduced the urea content compared with the control, maintaining bilirubin (with the combined action of gases) and creatinine within the initial values, which indicates a multi-organ protective effect. Against the background of the action of NO and H₂, a more pronounced decrease in circulating endothelial cells was noted, associated with a lower incidence of postoperative complications and MOF. The combined use of NO and H₂ caused a multi-organ protective effect superior to the effect of each gas.

Conclusion. Extracorporeal administration of NO and H₂ is an effective strategy for correcting myocardial and endothelial dysfunction, which helps prevent the development of multiple organ failure in cardiac surgery patients.

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