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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Nicorandil Infusion During Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump
Kamales Kumar Saha1, Ajay Kumar, Mandar Manohar Deval
1From the *Private practice, multiple private hospitals in Mumbai, India; †Fortis S. L. Raheja Hospital, Mumbai, India; and ‡MGM Medical College, Kamothe, Navi Mumbai, India.
Insights
Intraoperative nicorandil infusion significantly reduced the need for intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery, especially in high-risk patients with left ventricular dysfunction. This inexpensive intervention improves patient outcomes and reduces surgical costs.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Off-pump coronary artery bypass (OPCAB) grafting is advantageous for patients with left ventricular dysfunction.
- OPCAB carries a risk of emergency conversion to cardiopulmonary bypass, often necessitating intra-aortic balloon pump (IABP) insertion.
- Previous studies suggest IABP can prevent conversion, but its routine use adds risk and cost.
Purpose of the Study:
- To evaluate the efficacy of intravenous nicorandil infusion in reducing the incidence of intraoperative IABP insertion during OPCAB surgery.
- To assess the impact of nicorandil on high-risk patients with left ventricular dysfunction undergoing OPCAB.
Main Methods:
- A consecutive series of isolated OPCAB surgeries performed by a single surgeon were analyzed.
- Patients were divided into two groups: one receiving standard care without nicorandil, and the other receiving intraoperative nicorandil infusion.
- IABP insertion rates were compared between the two groups.
Main Results:
- A total of 375 patients were included in the study (excluding those preoperatively on IABP).
- The incidence of IABP insertion decreased significantly from 12.4% in the non-nicorandil group to 2.9% in the nicorandil group.
- This reduction was particularly significant in patients with left ventricular dysfunction (ejection fraction ≤ 30%).
Conclusions:
- Intravenous nicorandil infusion significantly reduces the need for intraoperative IABP insertion during OPCAB surgery.
- Nicorandil offers a significant benefit in high-risk patients with left ventricular dysfunction, improving safety and potentially outcomes.
- The use of nicorandil is cost-effective, reducing surgical costs by avoiding IABP insertion.
Objective:
Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion.
Methods:
Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion).
Results:
A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206).
Conclusions:
Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.
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