TITLE:
Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery
AUTHORS:
Mohamed A. W. Ezzat, Essam Elbadry Hashim Mohamed, Ayman Mohamed Abdel Ghaffar, Abdelhady Ahmed Helmy, Wesam Abdelgalil Aboelwafa, Eman Mohammad Ali
KEYWORDS:
Nicorandil for Myocardial Protection, Cardiopulmonary Bypass, Ischemia-Reperfusion Injury, Inflammatory Cytokines, Cardiac Valvular Surgery
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.9 No.10,
October
11,
2019
ABSTRACT: 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.