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Cardioprotection by nifedipine cardioplegia during coronary artery surgery
W Trubel1, W Zwoelfer, A Moritz
12nd Department of Surgery, University of Vienna, Austria.
Insights
Nifedipine added to cardioplegia significantly reduced cardiac damage and arrhythmias during heart surgery. This calcium channel blocker improved patient outcomes in coronary artery bypass grafting.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) requires myocardial protection.
- St. Thomas' cardioplegia is a standard solution for cardiac arrest during surgery.
- Calcium channel blockers may offer additional cardioprotective benefits.
Purpose of the Study:
- To evaluate the cardioprotective effect of nifedipine as an adjunct to St. Thomas' cardioplegia in CABG patients.
- To assess the impact of nifedipine on myocardial injury markers and cardiac function.
- To determine the effect on post-operative ischemia and arrhythmias.
Main Methods:
- Double-blind, placebo-controlled, randomized clinical trial.
- 24 patients undergoing CABG received St. Thomas' cardioplegia with either nifedipine (200 µg/L) or placebo.
- ECG, hemodynamic data, cardiac output, serum calcium, creatine phosphokinase (CK), CK-MB, and lactate were monitored.
Main Results:
- Nifedipine group showed a significantly lesser reduction in cardiac index post-bypass (P < 0.05).
- Lower post-operative serum CK and CK-MB levels were observed in the nifedipine group (P < 0.05).
- The placebo group experienced a significantly higher incidence of post-operative ischemia and cardiac arrhythmias.
Conclusions:
- Nifedipine as an adjunct to St. Thomas' cardioplegia provides significant cardioprotection during CABG.
- Nifedipine reduces myocardial injury and improves cardiac function post-operatively.
- Adjunctive nifedipine therapy may decrease the risk of ischemia and arrhythmias in CABG patients.
Abstract:
In a double-blind, placebo-controlled, randomized clinical study, the cardioprotective effect of nifedipine (Adalat, Bayer) as an adjunct to St. Thomas' cardioplegia was investigated in 24 patients undergoing coronary artery bypass grafting. Nifedipine at a dosage of 200 micrograms or placebo was added to each 1000 ml of St. Thomas solution, under strict light protection. ECG and haemodynamic data, including cardiac output measurements, serum calcium levels, creatine phosphokinase, (CK) CK-MB and lactate were measured during and after the operation. Additional cardioprotective effects were demonstrated in the nifedipine group by a significantly lesser reduction of the cardiac index after cardiopulmonary bypass and lower post-operative CK and CK-MB serum levels (P < 0.05). The incidence of ischaemia and cardiac arrhythmias was significantly higher in the placebo group on the post-operative ECG.