title: Nicorandil Infusion During Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion.
abstract: OBJECTIVE
  Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion.
  
  
  METHODS
  Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion).
  
  
  RESULTS
  A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206).
  
  
  CONCLUSIONS
  Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.
authors.affiliation: From the *Private practice, multiple private hospitals in Mumbai, India; †Fortis S. L. Raheja Hospital, Mumbai, India; and ‡MGM Medical College, Kamothe, Navi Mumbai, India.
authors.forename: Kamales Kumar
authors.initials: KK
authors.lastname: Saha
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.forename: Mandar Manohar
authors.initials: MM
authors.lastname: Deval
authors.forename: Kakalee K
authors.initials: KK
authors.lastname: Saha
authors.forename: Rinu V
authors.initials: RV
authors.lastname: Jacob
authors.forename: Lukash
authors.initials: L
authors.lastname: Jagdale
authors.forename: Shibban K
authors.initials: SK
authors.lastname: Kaul
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
chemical_list: D000889:Anti-Arrhythmia Agents; D020108:Nicorandil