Nicorandil reduces myocardial injury and improves cardiac function in valve replacement surgery.

Wael  Elfeky; Mohamed Aboelnasr; Ayman Sallam; Wael  Haseeb; Dalia R El-Afify

doi:10.35810/ects.v1i4.84

Wael Elfeky Cardiothoracic Surgery Department, Kafr Elsheikh Faculty of Medicine, Kafr Elsheikh, Egypt
Mohamed Aboelnasr Cardiothoracic Surgery Department, Tanta Faculty of Medicine, Tanta, Egypt
Ayman Sallam Cardiothoracic Surgery Department, Tanta Faculty of Medicine, Tanta, Egypt
Wael Haseeb Cardiology Department, Kafr Elsheikh Faculty of Medicine, Kafr Elsheikh, Egypt
Dalia R El-Afify Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Egypt

DOI: https://doi.org/10.35810/ects.v1i4.84

Keywords: Nicorandil, Ischemia-reperfusion injury, Cardiopulmonary bypass, Heart valve surgery, Myocardial protection, Oxidative stress, Inflammatory cytokines

Abstract

Background: Myocardial injury during cardiac surgery is associated with increased morbidity and mortality, and proper myocardial protection improves surgical outcomes. We aimed to study the role of preoperative nicorandil in myocardial protection during valve replacement surgery.

Methods: The study included 40 patients who were randomized into two groups: control group, and nicorandil group. Preoperative, intraoperative, and postoperative data were collected. Creatine kinase- MB (CK-MB), troponin I, malondialdehyde (MDA), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured 24-hours before surgery then 4, 12 and 48 hours after aortic cross-clamp removal.

Results: Nicorandil significantly decreased MDA (p=0.005 and 0.036), TNF-α (p< 0.001), IL-6 (p<0.001 and 0.003) 4 and 12 hours following the removal of aortic clamp compared to the control group. Additionally, It significantly reduced CK-MB (p< 0.0001 and 0.0002) and troponin-I (p= 0.0002 and < 0.0001) 4 and 12 hours after the removal of the aortic clamp, respectively. However, there was no significant difference in MDA, TNF-α, IL-6, CK-MB, and troponin-I levels between the nicorandil and the control group after 48 hours following the removal of aortic clamping (p= 0.084; 0.64; 0.12; 0.12; 0.75; respectively).

Conclusions: Nicorandil reduced myocardial injury significantly in valve replacement surgery. Nicorandil decreased CK-MB and troponin I and improved postoperative left ventricular ejection fraction.