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Myocardial protection by nicorandil during open-heart surgery under cardiopulmonary bypass
N K Chinnan1, G D Puri, S K S Thingnam
1Post Graduate Institute of Medical Education and Research, Department of Anaesthesia and Intensive Care, Chandigarh, India. nevinkc2001@yahoo.com
Insights
Nicorandil improves heart protection during open-heart surgery. This study found nicorandil (N) sped up heart arrest and reduced arrhythmias compared to placebo (P) in cardiac surgery patients.
Area of Science:
- Cardiology and Cardiac Surgery
- Pharmacology
- Cardioprotection
Background:
- Open-heart surgery often involves cardiopulmonary bypass (CPB) and cardioplegia for myocardial protection.
- Cold hyperkalemic cardioplegia is a standard method, but its efficacy can be enhanced.
- Nicorandil, a potassium channel opener, has shown potential cardioprotective properties.
Purpose of the Study:
- To evaluate the myocardial protective effect of nicorandil as an adjunct to cold hyperkalemic cardioplegia.
- To assess nicorandil's impact on cardiac function and outcomes during open-heart surgery.
Main Methods:
- A double-blind, randomized study involving 47 patients undergoing mitral valve replacement (MVR) or coronary artery bypass grafting (CABG).
- Patients received either nicorandil (0.1 mg/kg) or a placebo at three critical time points: pre-CPB, pre-cross-clamp, and pre-reperfusion.
- Key variables measured included time to electromechanical arrest, time to recovery of electrical activity, incidence of myocardial infarction, low output syndromes, and dysrhythmias.
Main Results:
- Nicorandil significantly accelerated the time to electromechanical arrest (Tarrest) in both MVR and CABG patients.
- Postoperative cardiac enzyme levels (CK-MB) were significantly lower in the nicorandil group for MVR patients.
- The incidence of intervention-requiring dysrhythmias post-aortic cross-clamp removal was reduced in the nicorandil group, with no significant adverse hemodynamic effects observed.
Conclusions:
- Nicorandil enhances the myocardial protective effect of cold hyperkalemic cardioplegia in cardiac surgery.
- The drug facilitates faster cardiac arrest and reduces the incidence of postoperative dysrhythmias.
- Nicorandil appears to be a safe and effective adjunct for improving myocardial protection during CPB.
Background:
To evaluate the myocardial protective effect of nicorandil when used as an adjuvant to cold hyperkalaemic cardioplegia in open-heart surgery.
Methods:
Patients who underwent surgery under cardiopulmonary bypass (CPB) for mitral valve replacement (MVR, 23 patients) or coronary artery bypass grafting (CABG, 24 patients) were entered in a double-blind study. The patients were randomized to a nicorandil Group (N) or placebo Group (P). Nicorandil 0.1 mg kg-1 (Group N), or normal saline (Group P), were administered at three time points: (1) after aortic cannulation, but prior to going on CPB, (2) 5 min before aortic cross-clamping and (3) 5 min before reperfusion. The following variables were studied: (a) time until electromechanical arrest after cardioplegia administration (Tarrest), (b) time until return of electromechanical activity after aortic cross-clamp removal (Trecovery), (c) incidence of postoperative myocardial infarction or low output syndromes (d) dysrhythmias requiring intervention after aortic cross-clamp removal and (e) haemodynamic changes after nicorandil administration.
Results:
The Tarrest after cardioplegia administration was significantly faster in nicorandil group in both MVR and CABG patients (P 75 IU L-1 in MVR patients was significantly lower in the Group N than in placebo patients (P < 0.05). However, in CABG patients there was no such significant difference. The incidence of dysrhythmias requiring intervention after aortic cross-clamp removal was also less in Group N. Administration of 0.1 mg kg-1 boluses of nicorandil did not cause significant haemodynamic changes or precipitate dysrhythmias in any patient.
Conclusion:
Nicorandil enhances the myocardial protective effect of cold hyperkalaemic cardioplegia in cardiac surgery patients.
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