Nitecapone as an additive to crystalloid cardioplegia in patients who had coronary artery bypass grafting

Background. Nitecapone has been shown to have a protective effect against i schemia-reperfusion injury in experimental heart transplantation and in Lan gendorff preparations. This prospective, randomized study assessed the effe cts of nitecapone in patients who had coronary artery bypass grafting. Methods. Thirty patients with normal myocardial function were randomly divi ded into control patients (n = 15), who received crystalloid (Plegisol) car dioplegia, and nitecapone patients, who received nitecapone in a 50 mu M so lution (n = 15) in Plegisol. Cardioplegia was administered as an initial do se of 15 mL/kg of body mass after cross-clamping and 2 mL/kg every 15 minut es. Simultaneous coronary sinus and aortic blood samples, and myocardial bi opsies were taken at 1, 5, and 10 minutes after unclamping. Hemodynamics we re measured invasively for 24 hours and with transesophageal echocardiograp hy for 3 hours after cardiopulmonary bypass. Results. There were no adverse effects; The incidence of ventricular arrhyt hmias was significantly lower in the treatment group during the recovery pe riod (p = 0.02). Cardiac output and stroke volume did not differ significan tly between the groups. The conjugated dienes gradient between the aorta an d the coronary sinus increased significantly during the first minute of rep erfusion in the control group (p = 0.02) compared with the nitecapone group . Myeloperoxidase activity in myocardial biopsies was higher in the control group (2.3 times higher at 5 minutes and 3.2 times higher at 10 minutes) t han in the nitecapone group (p = 0.13). Conclusions. Nitecapone did not exert any significant hemodynamic effects i n patients with normal ejection fraction. (C) 1999 by The Society of Thorac ic Surgeons.