Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery

• 作者: Abdelhady Ahmed Helmy Ayman Mohamed Abdel Ghaffar Eman Mohammad Ali Essam Elbadry Hashim Mohamed Mohamed A. W. Ezzat Wesam Abdelgalil Aboelwafa
• 来源期刊: 心血管病(英文)
• 学科: 医学
• 关键词: NICORANDIL for Myocardial Protection CARDIOPULMONARY BYPASS ISCHEMIA-REPERFUSION Injury Inflammatory Cytokines CARDIAC Valvular Surgery
• 年，卷（期）: 2019,（10）
• 页码范围: 707-717
• 页数: 11页
• 分类号: R54

摘要

Background: Reduction of myocardial reperfusion injury during cardiopulmonary bypass is an essential requirement for increasing the success rate, decreasing morbidity and mortality of open-heart surgery. Aim: To study the role of pre-operative oral nicorandil in decreasing reperfusion cardiac injury in patients subjected to cardiac valve surgery. Patients and Methods: The study included 62 patients, who were equally randomized into two groups: nicorandil group and control group. Pre-operative, intra-operative and post- operative data were reported and analyzed. Left Ventricle Ejection Fraction (LVEF) was estimated pre-operatively and postoperatively for both groups. Troponin I, creatine kinase-muscle/brain (CK-MB), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured before surgery by 24 hours then 4, 12 and 48 hours after aortic cross clamp removal. Results: Nicorandil considerably decreased TNF-α and IL-6 after 4 and 12 hours following the removal of aortic clamping. It also reduced troponin-I and CKMB at the same time points. However, there were no important changes in IL-6, TNF-α, troponin-I and CK-MB levels in control group in comparison to nicorandil group in the next 48 hours following the removal of aortic clamping. Conclusions: Pre-operative oral nicorandil expressively decreased myocardial reperfusion damage during open heart valve operations, this evidenced by the decrease in the postoperative use of inotropic drugs, considerable reduction of postoperative elevation of cardiac enzymes and inflammatory cytokines with no reported complications.