Papaverine Perfusion via the Aortic Root before Heart Re-beating Alleviates Myocardial Injury after Heart Valve Replacement

Aim. Myocardial injury is inevitable during cardiac surgical procedures and reducing myocardial injury in patients with CPB surgery is the focus of current research. Papaverine is accepted as an ideal coronary vasodilator. This study was to estimate the effect of papaverine perfusion via the aortic root before heart re-beating on patients undergoing heart valve replacement. Methods. All the patients enrolled in this study were admitted during 2013-2015. The basic clinical characteristics of the patients preoperative, intraoperative, and postoperative were compared. The immunochemistry assays and enzyme-linked immunosorbent assay (ELISA) were performed to assess the serum biomarkers. Western blot and immunohistochemistry (IHC) were undertaken to detect the expression of associated proteins. Results. Patients receiving papaverine perfusion via the aortic root before heart rebeating during heart valve replacement surgery under CPB showed less extracorporeal circulation time and CPB time, higher automatic heartbeat recovery rate, less mechanical ventilation time, shorter ICU and in-hospital stay, less leak of cTnI and CK-MB, and weaker inflammatory response than the patients in control group. In addition, the protein expression of IL-6/8/10 and TNF-alpha was reduced by the perfusion of papaverine. The IHC staining for NF-kappa B was depressed in papaverine group. Conclusion. Papaverine perfusion presented positive effect during valve replacement; this cardioprotective effect may be associated with inhibition of inflammatory response and NF-kappa B. These findings provided new clues for reduction of myocardial injury during cardiac surgery. (C) 2021 IMSS. Published by Elsevier Inc.

Automated summary

Perfusion of papaverine via the aortic root before heart rebeating during valve replacement surgery showed positive effects in reducing myocardial injury, inflammatory response, and NF-kappa B expression levels, leading to shorter mechanical ventilation time, ICU and in-hospital stay.