Effect of Nitric Oxide in Cardiac Surgery Patients With Endothelial Dysfunction.

Inclusion Criteria

• Provide written informed consent
• Age ≥ 18 years of age
• Elective cardiac or aortic surgery with CPB>90 minutes
• Stable pre-operative renal function without evidence of plasma creatinine level increase of ≥ 0.3 mg/dL over the prior 3 months and without renal replacement therapy (RRT).
• Clinical evidence of endothelial dysfunction assessed by a specifically designed questionnaire.

Exclusion Criteria

• eGFR less than 30 ml/min/1.73 m2
• Emergent cardiac surgery.
• Life expectancy 4 Wood Units.
• Left ventricular ejection fraction < 30% by echocardiography obtained within three months of enrollment
• Administration of one or more Packed Red Blood Cells (RBCs) transfusion in the week prior to enrollment.
• X-ray contrast infusion less than 48 hours before surgery.
• Evidence of intravascular or extravascular hemolysis from any other origin:

i. Intravascular: Intrinsic RBCs defects leading to hemolytic anemia (eg, enzyme deficiencies, hemoglobinopathies, membrane defects). Extrinsic: liver disease, hypersplenism, infections (eg, bartonella, babesia, malaria), treatment with oxidizing exogenous agents (eg, dapsone, nitrites, aniline dyes), exposure to other hemolytic agents (eg, lead, snake and spider bites), lymphocyte leukemia, autoimmune hemolytic disorders.

ii. Extravascular: Infection (eg, clostridial sepsis, severe malaria), paroxysmal cold hemoglobinuria, cold agglutinin disease, paroxysmal nocturnal hemoglobinuria, iv infusion of Rho(D) immune globulin, iv infusion of hypotonic solutions.