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Eur J Cardiothorac Surg 2003;23:670-677
© 2003 Elsevier Science NL

Superior myocardial protection with nicorandil cardioplegia

Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Breivika, P.O. Box 102, N-9038 Tromsø, Norway

Received 30 September 2002; received in revised form 20 January 2003; accepted 23 January 2003.

^* Corresponding author. Tel.: +47-77-626-000/637-338; fax: +47-77-628-298
e-mail: tors{at}fagmed.uit.no

Objective: The ATP-sensitive potassium channel (K_ATP) activator nicorandil used as cardioplegic agent may protect the left ventricle during cardiac arrest. Nicorandil in cold blood was compared with standard hyperkalemic blood and crystalloid cardioplegia. Methods: Twenty-one pigs were randomly assigned to three groups: (1) cold hyperkalemic crystalloid (n=7); (2) cold hyperkalemic blood (n=7); and (3) nicorandil as cardioplegia in cold blood (n=7). Left ventricular mechanical performance, pressure-volume area (PVA) and myocardial oxygen consumption (MVO₂) were measured before and at 1 and at 2 h after 60 min of cold global ischemia on cardiopulmonary bypass using intraventricular pressure-volume conductance catheters, coronary flow probes and O₂-content difference. Results: The slope (M_w) of the stroke work end-diastolic volume relationship, the preload recriutable stroke work relationship, was unchanged after ischemia in the nicorandil group, but was reduced to averaged 62.5% (standard deviation 14) of baseline values in both hyperkalemic perfusions (P<0.05). The slope of the MVO₂-PVA relationship was unchanged after nicorandil cardioplegia while the slope after hyperkalemic blood and crystalloid cardioplegia increased with 33% (P<0.02) and 52% (P<0.02) of baseline values, respectively. Conclusions: Nicorandil as sole cardioplegic agent in cold blood given intermittently preserves left ventricular contractility and myocardial energetics significantly better than traditional forms of cardioplegia after cardiac arrest.

Key Words: Cardioplegia • Energetics • Myocardial protection • Nicorandil

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