The Effects of Intracoronary Nicardipine on Ventricular Dynamics and Function in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Objective: To evaluate whether intracoronary nicardipine can provide myocardial protection in patients undergoing off-pump coronary artery bypass graft surgery. Design: Clinical trial. Setting: Single-institution, academic hospital. Participants: Off-pump coronary artery bypass patients with good ejection fraction. Interventions: Patients were divided into 2 equal groups: group A received 1 mL (0.1 mg) of intracoronary nicardipine before performing the distal anastomosis, and group B patients received 1 mL of NaCl in the coronary artery. Transesophageal echocardiography (PowerVision 6000, 9-mm 6-MHz probe; Toshiba, Elmsford, NY) was used in this study. Measurements and Main Results: Left ventricular ejection fraction, cardiac index, tissue Doppler imaging, velocity of the left ventricle and mitral annulus, and troponin levels were measured in both groups. The incidence of diastolic dysfunction as evaluated by superior pulmonary blood flow and pulsed-wave Doppler of the mitral annulus was significantly lower in group A. Tissue Doppler imaging velocity of the left ventricle and mitral annular displacement were significantly higher in the nicardipine group. Group A patients had significantly lower incidences of ST-segment changes, prolonged pharmacologic support in the postoperative period, and lower levels of troponin after surgery. Conclusion: Intracoronary nicardipine improves ventricular function in patients undergoing off-pump coronary artery bypass surgery.