Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

Kumar, Ajay; Deval, Mandar; Saha, Kamales Kumar; Jacob, Rinu; Jagdale, Lukash; Kaul, Shibban K

doi:10.1097/imi.0000000000000242

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Based on the mechanism of action, nicorandil may serve protective roles in myocardial and pulmonary injury. Nicorandil may become another major method of treating pulmonary injury associated with OLV (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Beneficial effect of the mitochondrial ATP‑sensitive potassium channel‑specific opener nicorandil on the collapsed lung via inhibition of apoptosis in clinical thoracic surgery

Wang

Wu²,

et al. 2023

Mol Med Rep

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Section: Discussionmentioning

confidence: 99%

Beneficial effect of the mitochondrial ATP‑sensitive potassium channel‑specific opener nicorandil on the collapsed lung via inhibition of apoptosis in clinical thoracic surgery

Wang

Wu²,

et al. 2023

Mol Med Rep

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“…Nicorandil, a Food and Drug Administration-approved mitoKATP-specific opener, activates the opening of the mito-KATP to protect cells. In the context of cardiology, several reports (12,13) have highlighted the key function in protecting the heart (14). However, only one study (15) has focused on the reduction of lung injury caused by cyclophosphamide.…”

Section: Protective Effect Of Nicorandil On Collapse-induced Lung Injmentioning

confidence: 99%

Protective effect of nicorandil on collapse‑induced lung injury in rabbits by inhibiting apoptosis

Wang

et al. 2019

Int J Mol Med

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The one-lung ventilation (OLV) technique is vital in thoracic surgery. However, it can result in severe lung injury, which is difficult to manage. The main solution at present is the use of ventilation strategies, including continuous positive oxygen pressure, low tidal volume and high frequency ventilation, and the administering of drugs, including phenylephrine, dexmedetomidine and morphine. However, the protective effect of these methods on the lungs is not sufficient to improve the prognosis of patients. Therefore, how to develop a novel protective drug remains an open question. Nicorandil, a mitochondrial (mito)KATP-specific opener, serves an important role in cardioprotection, although its effect on lung injury remains unclear. The present study examined the protective role of nicorandil against collapse-induced lung injury in rabbits undergoing OLV. changes in arterial oxygen saturation (SaO 2), arterial partial pressure for oxygen (PaO 2), wet/dry weight ratio, and the microstructure of tissues and cells were observed. Enzyme-linked immunosorbent assays were used to determine the concentrations of malondialdehyde (MDA) and tumor necrosis factor (TNF)-α, and the activity of superoxide dismutase (SOD) in rabbits treated with nicorandil. Terminal deoxynucleotidyl transferase transfer-mediated dUTP nick end-labeling was used to detect apoptosis and western blotting was used to analyze the relative proteins involved in apoptosis. Western blotting and reverse transcription-quantitative polymerase chain reaction analysis were used to examine the expression of hypoxia inducible factor 1α (HIF-1α), phosphatidylinositol-3-kinase (PI3K), protein kinase B (Akt) and nuclear factor (NF)-κB in the lungs of rabbits treated with nicorandil. The SaO 2 and PaO 2 in the high-dose group were significantly higher than those in the control group in the process of OLV. The wet/dry weight ratio, and the concentrations of MdA and TNF-α in the collapsed lung of the high-dose group were significantly lower than those in the control group. The activity of SOD in the high-dose group was significantly higher than that in the control group. The lung had improved microstructure and less apoptosis, which was determined by the Bax/Bcl2 ratio in the high-dose group. The expression levels of PI3K, phosphorylated Akt and HIF-1α were upregulated, whereas the expression of NF-κB was downregulated. In conclusion, nicorandil had a protective effect via inhibiting apoptosis in non-ventilated lung collapsed and re-expansion during OLV in the rabbit. It acted on mitoKATP through the PI3K/Akt signaling pathway.

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“…Routine surgical audit had detected that Nicorandil infusion during OPCAB may improve hemodynamic stability particularly in patients with left Meeting presentation: None * Kamales Kumar Saha kamalessk@gmail.com ventricular dysfunction. Later, the data was analyzed, presented, and published [3]. Practical problems of publication: Lack of credible Indian published data is a major deterrent.…”

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confidence: 99%

Off-pump coronary bypass grafting: the new gold standard!

Saha

2017

Indian J Thorac Cardiovasc Surg

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Off-pump coronary artery bypass (OPCAB) surgery is an evolution in the field of cardiac surgery which helped keep up with rapid technological advances in the field of percutaneous coronary intervention (PCI). In spite of the cardiologist being the Bgate keeper^for referring patients for PCI or surgery, preference for OPCAB has grown over on-pump coronary artery bypass grafting surgery (ONCAB). The advantages of OPCAB over ONCAB can be debated and the final verdict is yet to come [1]. In India OPCAB has become the preferred mode of revascularization in private health care system. This is because surgeons who are efficient in OPCAB often migrate to private hospitals for better compensation. Private hospitals use proficiency in OPCAB as one of the major criteria for selecting surgeons. The polarization is complete in private sector in favor of OPCAB. Cardiologists are the end result assessor of both procedures. In spite of the obvious conflict of interest, OPCAB remains the preferred mode of revascularization over both PCI and ONCAB.However, in western world the situation is different probably because healthcare is funded by either insurer or tax-payer. The patient prefers the less invasive procedure even though it may not necessarily be the treatment with best long-term result. The insured patient is not deterred by the possibility of a costly second procedure after PCI. That is why major hindrance to development of OPCAB in western world is probably the stent industry. If superiority of OPCAB is established, stent industry will incur huge revenue loss. Any trial publishing inferior OPCAB results is often highlighted in western literature. All trials comparing coronary artery bypass grafting (CABG) and PCI have proven that stroke is the Achilles' heel of CABG. OPCAB with aortic no touch can eliminate this disparity. It is not surprising that no single trial is designed to compare OPCAB with aortic no touch to multivessel PCI. Even arterial revascularisation therapy study (ARTS) had only 40% OPCAB patients [2].In spite of growing popularity there are few OPCAB publications from India. There are various factors for lack of Indian publications:Reluctant to publish: Surgeons with good results are often reluctant to publish. With experience, we learn many tricks, and unless we share with the future generation, these tricks will not survive. By publishing our technique and results, we can share our experience beyond geographical borders. Inadequate prospective data collection: Prospective data collection is often neglected in our country across all centers. Case papers are destroyed after 5 years, the mandatory period by law. Prospective collection of preoperative and postoperative data is required. We need to move to electronic record keeping so that the collected data can be preserved, accessed, and analyzed. We can only publish superior OPCAB results if we have access to properly collected patient data. Lack of regular self audit: Regular self audit is mandatory for quality improvement. Sometimes regular self audit c...

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Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

Cited by 5 publications

References 14 publications

Beneficial effect of the mitochondrial ATP‑sensitive potassium channel‑specific opener nicorandil on the collapsed lung via inhibition of apoptosis in clinical thoracic surgery

Beneficial effect of the mitochondrial ATP‑sensitive potassium channel‑specific opener nicorandil on the collapsed lung via inhibition of apoptosis in clinical thoracic surgery

Protective effect of nicorandil on collapse‑induced lung injury in rabbits by inhibiting apoptosis

Off-pump coronary bypass grafting: the new gold standard!

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