REDUCTION OF REPERFUSION INJURY OF HUMAN MYOCARDIUM BY ALLOPURINOL - A CLINICAL-STUDY

To determine the possibility of myocardial protection against reperfus ion injury by allopurinol, 22 aortocoronary bypass patients were studi ed. Eight patients received allopurinol (200 mg during induction of an esthesia and 100 mg after starting extracorporeal circulation) during surgery (group B), and 14 patients served as a control (group A). Bloo d samples and myocardial biopsies were taken before and 10 min after a ortic cross-clamping. No statistically significant difference between the two groups was observed considering gender, age, prior myocardial infarction, left ventricular end diastolic pressure (LVEDP), and aorti c cross-clamp time. Preservation of cardiac tissue was assessed by the measurement of quantitative birefringence (QBR) changes upon the addi tion of adenosine 5'-triphosphate (ATP) plus calcium in biopsies and t he need for postoperative inotropes. The synthesis of peroxides was es timated by the measurement of leukotriene B-4 and C-4 (LTB(4), LTC(4)) . LTB(4) was below the level of detection (< 1.5 ng/l) before and afte r cross-clamping in both groups, while the LTC(4) level for group A in creased from < 1.5 to 27 +/- 17 ng/l compared to an increase of < 1.5 to 11 +/- 8 ng/l for group B after 10 min of reperfusion (p = .036). T he decrease in QBR value in group A was 1.26 +/- 0.28 and 0.35 +/- 0.2 3 for group B (p < .003). Postoperatively, 11 out of 14 patients in gr oup A needed inotropic support (dopamine or dobutamine), whereas two p atients out of eight did so in group B. Peroperative myocardial infarc tion was diagnosed (based on serial creatinine kinase-MB [CK-MB] measu rements and electrocardiogram [EGG] changes) in two patients of group A, while no infarction was detected in group B. The results indicate t hat allopurinol reduced ischemia reperfusion injury during open heart surgery.