Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery - World Journal of Cardiovascular Diseases

WJCD > Vol.9 No.10, October 2019

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

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Download as PDF (Size: 459KB) PP. 707-717

DOI: 10.4236/wjcd.2019.910064 395 Downloads 1,149 Views Citations

Author(s)

Mohamed A. W. Ezzat¹, Essam Elbadry Hashim Mohamed², Ayman Mohamed Abdel Ghaffar², Abdelhady Ahmed Helmy³, Wesam Abdelgalil Aboelwafa³, Eman Mohammad Ali⁴

Affiliation(s)

¹Internal Medicine and Cardiology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
²Cardiothoracic Surgery Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
³Anesthesia and Intensive Care Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
⁴Pharmacology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.

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.

KEYWORDS

Nicorandil for Myocardial Protection, Cardiopulmonary Bypass, Ischemia-Reperfusion Injury, Inflammatory Cytokines, Cardiac Valvular Surgery

Share and Cite:

Ezzat, M. , Mohamed, E. , Ghaffar, A. , Helmy, A. , Aboelwafa, W. and Ali, E. (2019) Cardio-Protective Effects of Oral Nicorandil in Patients Undergoing Cardiac Valve Surgery. World Journal of Cardiovascular Diseases, 9, 707-717. doi: 10.4236/wjcd.2019.910064.

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