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J Thorac Cardiovasc Surg 1995;110:1063-1072
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

PROTECTIVE EFFECT OF NICORANDIL AS AN ADDITIVE TO THE SOLUTION FOR CONTINUOUS WARM CARDIOPLEGIA

London, England

Supported in part by grants from the British Heart Foundation and STRUTH.

Received for publication Jan. 12, 1995. Accepted for publication April 12, 1995. Address for reprints: Yumin Qiu, MD, PhD, Section of Cardiology, University of Louisville, Louisville, KY 40202.

Abstract

Experiments were designed to assess whether (1) nicorandil given before global low-flow ischemia or (2) included in low-flow continuous cardioplegia improved the recovery of cardiac function in the isolated rat heart. The first investigated the effect of nicorandil (2, 10, or 100µmol/L), given for 3 minutes before 30 minutes of normothermic global ischemia, on recovery after 30 minutes of reperfusion. In aerobically perfused hearts, doses of 10 and 100µmol/L significantly increased coronary flow; the dose of 100µmol/L exerted a negative inotropic effect. These doses shortened the time to contractile arrest (282±18 and 276±22 seconds versus 354±16 seconds in the control hearts with unmodified ischemia; p <0.05 in both instances). Nicorandil also improved the postischemic recovery of coronary flow (79.1%±1.7% and 78.0%±1.6%, respectively, versus 71%±1.8%; p <0.05). However, there was no significant improvement in recovery of contractile function, creatine kinase leakage, or tissue adenosine triphosphate and creatine phosphate contents. Second, pretreatment with nicorandil (10µmol/L) was shown to increase susceptibility of the hearts to reperfusion-induced ventricular fibrillation from 0% (n = 8) in control hearts to 50% in the drug-treated group (p <0.05). Third, nicorandil (10µmol/L) was added to cardioplegic and noncardioplegic solutions infused into the coronary tree throughout 100 minutes of low-flow (0.7 ml/min) ischemia: in eight of nine control hearts electrical activity was maintained throughout, whereas in all nicorandil-treated hearts electrical activity was suppressed for at least part of the time. Nicorandil also reduced the prevalence of ischemic contracture to 0% during continuous infusion of cardioplegic solution (compared with 30% in nicorandil-free control hearts) and improved the recovery of contractile function after 40 minutes of reperfusion. Thus, in the noncardioplegia groups, left ventricular developed pressure recovered to 77.8%±4.0% versus 51.7%±2.6% in control hearts (p <0.05) and in the cardioplegia groups to 96.2%±4.2% versus 79.7%±5.5% (p <0.05). Ventricular compliance (the ventricular volume required to achieve a left ventricular end-diastolic pressure of 4 mm Hg) was better preserved in the nicorandil-containing noncardioplegia group (133±6µl) than in the control group (88±10µl; p <0.05). In conclusion, nicorandil has been shown to (1) reduce ischemic contracture, (2) lessen the effects of ischemic arrest, and (3) improve the postischemic recovery of contractile function. In this species and preparation it may, however, enhance vulnerability to reperfusion-induced arrhythmias. (J THORACCARDIOVASCSURG1995;110:1063-72)

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