Effect of preoperative administration of allopurinol in patients undergoing surgery for valvular heart diseases.
OBJECTIVE
To assess the effects of preoperative administration of allopurinol in patients undergoing open-heart surgery (OHS) for valvular heart diseases.


METHODS
In this prospective randomised double-blind study, 50 consecutive patients undergoing OHS for valvular heart disease were randomised into two groups of 25 patients each: (a) control group received placebo and (b) test group received allopurinol prior to surgery. Serum troponin T and creatine phosphokinase-MB (CPK-MB) isoenzymes were measured prior to the induction of anaesthesia, at the time of aortic cross-clamp release and 24h following termination of cardiopulmonary bypass. Postoperatively assessed parameters were inotropic score, rhythm, and duration of mechanical ventilation and occurrence of a low cardiac output state.


RESULTS
Significant differences were observed with respect to inotropic score: median 5 ((0-25) vs 0 (0-25) p=0.027) and mean 6.44+/-6.145 versus 3.4+/-5.54, mean duration of mechanical ventilation (11.1+/-4.9 vs 7.5+/-2.5 h, p=0.002, hospital stay (6.35+/-1.43 vs 5.04+/-0.611, p=0.001) and maintenance of normal sinus rhythm (NSR) (18 vs 25, p=0.004) between the control groups versus the test group, respectively. There were no significant differences in the levels and trends of troponin T and CPK-MB between the two groups.


CONCLUSIONS
The administration of allopurinol prior to OHS for valvular heart diseases is associated with increased conversion and maintenance to normal sinus rhythm, reduced inotropic score and a reduction in the duration of mechanical ventilation and hospital stay. There was, however, no significant difference in the blood levels of CPK-MB and troponin T and a large sample size is required to assess this further.
Talwar
Sachin
S
Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. sachintalwar@hotmail.com
Sandeep
Janardhan Alamanda
JA
Choudhary
Shiv Kumar
SK
Velayoudham
Devagourou
D
Lakshmy
Ramakrishnan
R
Kasthuri
Jeeva Mani
JM
Kumar
Arkalgud Sampath
AS
D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D052279:Creatine Kinase, MB Form / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011229:Preanesthetic Medication; D012121:Respiration, Artificial; D020107:Troponin T / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D016166:Free Radical Scavengers; D020107:Troponin T; D000493:Allopurinol; D052279:Creatine Kinase, MB Form