Figure 1.

Nitric oxide in perioperative organ protection. The modern paradigm of the pathogenesis of perioperative myocardial and kidney injuries in cardiovascular surgery implies a close relationship of organ complications in the heart–kidney axis. The additive potentiation of multiple organ dysfunction is referred to as the cardiorenal continuum and includes both the direct association of cardiac dysfunction with the development of AKI (cardiorenal syndrome type 1) and reversible myocardial injury in the manifestation of AKI (cardiorenal syndrome type 3-acute renocardiac syndrome). The figure illustrates the fundamental basis for targeted perioperative prevention of organ dysfunction. NO therapy may prevent the cardiorenal continuum in cardiac surgery through a pluripotent positive effect on mitochondrial and microcirculatory distress in the heart–kidney axis. NB: Right ventricle (RV); oxyhemoglobin (OxyHb); methemoglobin (MetHb); glomerular filtration rate (GFR).