Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery?

Allah, Essam Abd; Kamel, Emad Zarief; Osman, Hany M.; Abd‐Elshafy, Sayed Kaoud; Nabil, Fatma; ElMelegy, Tarek T; Elkhayat, Hussein; Ibrahim, Abdelrady S; Minshawy, Ahmed Al

doi:10.1053/j.jvca.2019.05.013

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…One thousand two hundred forty-four patients were pretreated with atorvastatin or placebo. 25–29,32–37 Atorvastatin use was correlated with a reduced prevalence of POAF (21.2% vs. 32.6%). The difference between the 2 treatments was statistically significant (OR, 0.54; 95% CI: 0.41–0.70, P < 0.00001).…”

Section: Resultsmentioning

confidence: 97%

“…Fourteen studies comprising 2883 patients reported the prevalence of POAF in patients pretreated with statins or placebo. 25–38 In the primary analysis, statins reduced the risk of POAF (21.4% vs. 27.5%, OR, 0.71; 95% CI: 0.60–0.85, P = 0.0001). Severe heterogeneity was observed (I 2 = 69%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows the characteristics of the 14 RCTs. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] The overall number of patients included in the meta-analysis was 2883. Eleven RCTs compared atorvastatin with placebo, whereas the remaining 3 compared rosuvastatin with placebo.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Statin and Postcardiac Surgery Atrial Fibrillation Prevention: A Systematic Review and Meta-Analysis

Oliveri

Bongiorno

Compagnoni

et al. 2022

Journal of Cardiovascular Pharmacology

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

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Statin and Postcardiac Surgery Atrial Fibrillation Prevention: A Systematic Review and Meta-Analysis

Oliveri

Bongiorno

Compagnoni

et al. 2022

Journal of Cardiovascular Pharmacology

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“…In addition, the pleiotropic beneficial effects of statins have been widely described, hence their widespread use in cardiac surgery patients (150,151). Although the administration of statins in the preoperative phase of cardiac surgery has recently been shown to be ineffective, physicians must be aware that these drugs can cause a rebound effect (152)(153)(154). Postoperative statin withdrawal was an independent predictor of postoperative myocardial infarction after major vascular surgery (155).…”

Section: The Postoperative Periodmentioning

confidence: 99%

Myocardial protection in cardiac surgery: a comprehensive review of current therapies and future cardioprotective strategies

Chiari,

Fellahi

2024

Front. Med.

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Cardiac surgery with cardiopulmonary bypass results in global myocardial ischemia–reperfusion injury, leading to significant postoperative morbidity and mortality. Although cardioplegia is the cornerstone of intraoperative cardioprotection, a number of additional strategies have been identified. The concept of preconditioning and postconditioning, despite its limited direct clinical application, provided an essential contribution to the understanding of myocardial injury and organ protection. Therefore, physicians can use different tools to limit perioperative myocardial injury. These include the choice of anesthetic agents, remote ischemic preconditioning, tight glycemic control, optimization of respiratory parameters during the aortic unclamping phase to limit reperfusion injury, appropriate choice of monitoring to optimize hemodynamic parameters and limit perioperative use of catecholamines, and early reintroduction of cardioprotective agents in the postoperative period. Appropriate management before, during, and after cardiopulmonary bypass will help to decrease myocardial damage. This review aimed to highlight the current advancements in cardioprotection and their potential applications during cardiac surgery.

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“…In a study with 64 adult patients undergoing cardiac valve replacement surgery, oral administration of 80 mg of atorvastatin (12 and 2 h preoperatively and on the 2nd, 3rd, 4th and 5th post-operative days) caused a reduction in POAF incidence [ 78 ]. In addition, the patients showed a less intense inflammatory process.…”

Section: Antioxidants In Arrhythmia Treatmentmentioning

confidence: 99%

Antioxidants in Arrhythmia Treatment—Still a Controversy? A Review of Selected Clinical and Laboratory Research

Szyller

Jagielski²,

Bil‐Lula

2022

Antioxidants

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Antioxidants are substances that can prevent damage to cells caused by free radicals. Production of reactive oxygen species and the presence of oxidative stress play an important role in cardiac arrhythmias. Currently used antiarrhythmic drugs have many side effects. The research on animals and humans using antioxidants (such as vitamins C and E, resveratrol and synthetic substances) yields many interesting but inconclusive results. Natural antioxidants, such as vitamins C and E, can reduce the recurrence of atrial fibrillation (AF) after successful electrical cardioversion and protect against AF after cardiac surgery, but do not affect the incidence of atrial arrhythmias in critically ill patients with trauma. Vitamins C and E may also effectively treat ventricular tachycardia, ventricular fibrillation and long QT-related arrhythmias. Another natural antioxidant—resveratrol—may effectively treat AF and ventricular arrhythmias caused by ischaemia–reperfusion injury. It reduces the mortality associated with life-threatening ventricular arrhythmias and can be used to prevent myocardial remodelling. Statins also show antioxidant activity. Their action is related to the reduction of oxidative stress and anti-inflammatory effect. Therefore, statins can reduce the post-operative risk of AF and may be useful in lowering its recurrence rate after successful cardioversion. Promising results also apply to polyphenols, nitric oxide synthase inhibitors and MitoTEMPO. Although few clinical trials have been conducted, the use of antioxidants in treating arrhythmias is an interesting prospect.

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Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery?

Cited by 5 publications

References 26 publications

Statin and Postcardiac Surgery Atrial Fibrillation Prevention: A Systematic Review and Meta-Analysis

Statin and Postcardiac Surgery Atrial Fibrillation Prevention: A Systematic Review and Meta-Analysis

Myocardial protection in cardiac surgery: a comprehensive review of current therapies and future cardioprotective strategies

Antioxidants in Arrhythmia Treatment—Still a Controversy? A Review of Selected Clinical and Laboratory Research

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