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Eur J Cardiothorac Surg 2007;31:360-365. doi:10.1016/j.ejcts.2006.11.042
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Pretreatment with aminophylline reduces release of Troponin I and neutrophil activation in the myocardium of patients undergoing cardioplegic arrest

Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, PR China

Received 17 August 2006; received in revised form 26 November 2006; accepted 28 November 2006.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Xiang Ya Hospital, Changsha, Hunan 410008, PR China. Tel.: +86 731 4310800; fax: +86 731 4327247. (Email: luowanjun{at}yahoo.com).

Objective: Cardioplegic arrest and subsequent reperfusion results in myocardial injury partly related to local inflammation in the heart. It has been proven that aminophylline has numerous anti-inflammatory effects. This study has been designed to evaluate the effects of aminophylline used as a cardioprotective agent for patients undergoing cardiopulmonary bypass (CPB) for valve replacement. Methods: Thirty patients undergoing elective valve replacement were randomized to receive either aminophylline (n = 15), or normal saline (control n = 15). Administration of aminophylline (5 mg/kg) was injected intravenously after induction of anesthesia. The cardiac Troponin I (cTnI), myocardial myeloperoxidase (MPO) activity, atrial cyclic AMP, and a coronary sinus neutrophil count were measured before and after cardioplegic arrest. Results: There were no differences between the two groups with regard to clinical variables. The cTnI concentration increased significantly after aortic declamping in both groups. However, it was significantly lower, 8 h after aortic declamping, in aminophylline group (1.00 ± 0.41 vs 2.37 ± 1.35 ng/ml p = 0.038). The atrial cAMP was significantly higher before aortic cross-clamping in aminophylline group (42.5 ± 6.7 pmol/g tissue vs 30.6 ± 12.4 pmol/g tissue p = 0.04). In addition, we found that the aminophylline group had a significantly lower MPO after reperfusion (1.50 ± 0.58 U/g tissue vs 0.86 ± 0.24 U/g tissue p = 0.003), and a significantly lower neutrophil count 30 min after aortic declamping (0.68 ± 0.11 x 10³ cell/ml vs 0.32 ± 0.16 x 10³ cell/ml, p = 0.023). Conclusions: Pretreatment with intravenous aminophylline reduces the subclinical myocardial injury and neutrophil activation in patients undergoing CPB for valve replacement.

Key Words: Aminophylline • Tropnin I • Neutrophil • Myocardium protection

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