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Use of nifedipine to decrease ischemic-reperfusion injury in the surgical setting.

R E Clark, I Y Christlieb, J C Vanderwonde

    The American Journal of Cardiology
    |January 25, 1985
    PubMed
    Summary
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    Nifedipine in cold hyperkalemic cardioplegic solution effectively reduced myocardial injury and improved hemodynamic variables in high-risk patients during cardiac surgery. Its efficacy, however, depends on dose, vehicle, and species.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Cardiovascular Surgery

    Background:

    • Cold hyperkalemic cardioplegia is standard for myocardial protection during cardiac surgery.
    • Calcium channel blockers, like nifedipine, may enhance myocardial protection.
    • Previous studies investigated nifedipine's role in preventing ischemia-reperfusion injury.

    Purpose of the Study:

    • To evaluate the efficacy of nifedipine in cold hyperkalemic cardioplegic solution for myocardial protection.
    • To provide a basis for a randomized clinical trial of nifedipine in this context.
    • To assess nifedipine's impact on myocardial stiffness, calcium accumulation, and post-operative outcomes.

    Main Methods:

    • Utilized isolated working rabbit heart models to assess nifedipine's effect on stiffness and calcium.

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  • Conducted studies in open-chest dogs comparing nifedipine with sodium nitroprusside during ischemia and reperfusion.
  • Performed cardiopulmonary bypass experiments in dogs at various temperatures and durations of global ischemia.
  • Executed a randomized clinical trial in high-risk cardiac surgery patients.

    • Main Results:

    • Nifedipine prevented increases in systolic and diastolic stiffness and intracellular calcium accumulation in rabbit hearts.
    • Nifedipine demonstrated superiority over sodium nitroprusside in preserving hemodynamic variables and reducing myocardial injury in dogs.
    • Significant efficacy of nifedipine was observed in dog cardiopulmonary bypass experiments across different temperatures and ischemic durations.
    • The clinical trial showed a reduced incidence of low cardiac output syndrome and improved hemodynamics in nifedipine-treated patients.
    • Post-operative radionuclide scans revealed no myocardial injury in the nifedipine-treated group.

    Conclusions:

    • Nifedipine is efficacious when incorporated into cold hyperkalemic cardioplegic solutions for myocardial protection.
    • Observed responses to nifedipine are dependent on dosage, vehicle, and species.
    • Nifedipine shows promise in improving outcomes for high-risk cardiac surgery patients.