Pretreatment with aminophylline reduces release of Troponin I and neutrophil activation in the myocardium of patients undergoing cardioplegic arrest.
OBJECTIVE
Cardioplegic arrest and subsequent reperfusion results in myocardial injury partly related to local inflammation in the heart. It has been proven that aminophylline has numerous anti-inflammatory effects. This study has been designed to evaluate the effects of aminophylline used as a cardioprotective agent for patients undergoing cardiopulmonary bypass (CPB) for valve replacement.


METHODS
Thirty patients undergoing elective valve replacement were randomized to receive either aminophylline (n=15), or normal saline (control n=15). Administration of aminophylline (5mg/kg) was injected intravenously after induction of anesthesia. The cardiac Troponin I (cTnI), myocardial myeloperoxidase (MPO) activity, atrial cyclic AMP, and a coronary sinus neutrophil count were measured before and after cardioplegic arrest.


RESULTS
There were no differences between the two groups with regard to clinical variables. The cTnI concentration increased significantly after aortic declamping in both groups. However, it was significantly lower, 8h after aortic declamping, in aminophylline group (1.00+/-0.41 vs 2.37+/-1.35 ng/ml p=0.038). The atrial cAMP was significantly higher before aortic cross-clamping in aminophylline group (42.5+/-6.7 pmol/g tissue vs 30.6+/-12.4 pmol/g tissue p=0.04). In addition, we found that the aminophylline group had a significantly lower MPO after reperfusion (1.50+/-0.58 U/g tissue vs 0.86+/-0.24 U/g tissue p=0.003), and a significantly lower neutrophil count 30 min after aortic declamping (0.68+/-0.11x10(3) cell/ml vs 0.32+/-0.16x10(3) cell/ml, p=0.023).


CONCLUSIONS
Pretreatment with intravenous aminophylline reduces the subclinical myocardial injury and neutrophil activation in patients undergoing CPB for valve replacement.
Luo
Wan-Jun
WJ
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, PR China. luowanjun@yahoo.com
Qian
Jian-Fang
JF
Jiang
Hai-He
HH
D000328:Adult; D000628:Aminophylline / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000494:pharmacology; D000242:Cyclic AMP / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006321:Heart / Q000187:drug effects*; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D018375:Neutrophil Activation / Q000187:drug effects*; D009504:Neutrophils / Q000473:pathology; D009195:Peroxidase / Q000378:metabolism; D012214:Rheumatic Heart Disease / Q000601:surgery; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
D002316:Cardiotonic Agents; D019210:Troponin I; D000628:Aminophylline; D000242:Cyclic AMP; D009195:Peroxidase