Role of Prophylactic N-Acetylcysteine Supplementation on Postoperative Outcomes in Patients Undergoing Elective Double-Valve Replacement (Aortic and Mitral Valve)

• Published in: Annals of cardiac anaesthesia 2024-10, Vol.27 (4), p.324-329
• Main Authors: Ram Kiran, K S, Trivedi, Visharad, Rajesh, Venuthurupalli S. P, Sharma, Manisha, Haranal, Maruti, Pandya, Himani
• Format: Article
• Language: English
• Subjects: Acetylcysteine; Analysis; Atrial fibrillation; Bilirubin; C-reactive protein; cardiopulmonary bypass; Coronary artery bypass; Digital video recorders; Heart valve diseases; hepatic dysfunction; high liver enzymes; Liver; Liver diseases; Medical research; Medicine, Experimental; Mortality; n-acetylcysteine; Original; Patient outcomes; Postoperative period; Ventilation; Ventilators
• ISSN: 0971-9784; 0974-5181
• DOI: 10.4103/aca.aca_66_24

ABSTRACT Aims and Objectives: The incidence of postoperative liver dysfunction is high in patients undergoing double-valve replacement - mitral and aortic valve replacement (DVR). This study aims to evaluate N-acetylcysteine's free radical scavenging property (NAC) to prevent postoperative liver dysfunction in these patients, thus affecting overall clinical outcomes. Methods: A single-center, prospective, randomized, double-blinded interventional study of 60 patients divided into two groups of 30 each. Group N received prophylactic intravenous NAC, and Group C received volume-matched 5 dextrose. Data comprised demographics, liver function tests (LFT), renal function tests (RFT), vasoactive-inotropic scores (VIS) score, and C-reactive protein (CRP) at various time intervals. Postoperative parameters such as ventilation duration, length of stay in ICU (LOS-ICU), length of hospital stay (LOHS), atrial fibrillation (AF), acute kidney injury (AKI) requiring hemodialysis, and mortality were noted. Statistical analysis was performed with the Student's t-test and Chi-square test (SPSS 22 software). Results: All postoperative LFT parameters (total bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT), and alkaline phosphatase (ALP)) were significantly lower (P < 0.05) at 24, 48, and 72 hours in Group N compared to Group C. RFT and VIS scores were lower in Group N; however, were not statistically significant except for Serum Creatinine at 48 hours (P = 0.0478). Ventilation duration (P = 0.0465) and LOS-ICU (P = 0.0431) were significantly lower in Group N. Other outcomes like AF, LOHS, and mortality were lower in Group N but were not statistically significant. Conclusion: Our study showed that prophylactic administration of NAC in patients undergoing DVR is associated with a reduction in the incidence of postoperative liver dysfunction with a positive impact on postoperative outcomes. Keywords: Cardiopulmonary bypass, hepatic dysfunction, high liver enzymes, N-acetylcysteine