Saha Kamales Kumar, Kumar Ajay, Deval Mandar Manohar, Saha Kakalee K, Jacob Rinu V, Jagdale Lukash, Kaul Shibban K
From the *Private practice, multiple private hospitals in Mumbai, India; †Fortis S. L. Raheja Hospital, Mumbai, India; and ‡MGM Medical College, Kamothe, Navi Mumbai, India.
Innovations (Phila). 2016 Mar-Apr;11(2):123-7. doi: 10.1097/IMI.0000000000000242.
Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion.
Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion).
A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206).
Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.
已证实，在左心室功能不全患者中进行非体外循环冠状动脉旁路移植术具有优势。然而，它存在紧急转为体外循环的风险。我们成功地使用主动脉内球囊反搏来预防这种转变。本研究的目的是评估静脉输注尼可地尔是否能降低术中主动脉内球囊反搏置入的发生率。
对由单一外科医生进行的连续非体外循环冠状动脉旁路移植手术病例进行研究。患者分为两组。第一组未接受尼可地尔，第二组术中接受尼可地尔输注（在插入中心静脉导管后于手术室开始）。
共有375例患者纳入研究。非尼可地尔组的4例患者和尼可地尔组的患者术前已使用主动脉内球囊反搏，因此被排除在研究之外。在常规使用尼可地尔输注后，非体外循环冠状动脉旁路移植手术期间主动脉内球囊反搏置入的发生率从12.4%（21/169）降至2.9%（6/206）。
在我们的系列研究中，尼可地尔输注显著（P = 0.007）降低了主动脉内球囊反搏置入的发生率。在左心室功能不全（射血分数≤30%）的患者中，这种差异（P = 0.008）具有特殊意义，因为在这一亚组中，非体外循环旁路手术被认为是高风险的。尼可地尔是一种廉价药物，通过避免主动脉内球囊反搏置入来降低手术成本是一个额外的优势。在非体外循环冠状动脉旁路移植术中使用尼可地尔输注，可能通过减少非体外循环冠状动脉旁路移植术中侵入性主动脉内球囊反搏的置入，从而带来良好的患者预后。
