Ranolazine a Potential New Therapeutic Application
Status:
Withdrawn
Trial end date:
2020-10-01
Target enrollment:
Participant gender:
Summary
Despite surgical and medical innovation have reduced mortality rates in cardiac surgery, the
disease severity and operative procedural complexity have increased and morbidity rate is
still high. Ischemia-reperfusion (I/R) injury, redefined in cardiac surgery
"post-cardioplegic injury" (2) as a whole of ischemia-reperfusion, cardiopulmonary bypass and
surgical trauma, has been recognized as a significant contributor to mortality and morbidity.
I/R injury is classified as reversible or irreversible. Reversible injury includes
arrhythmias, edema, vascular dysfunction and contractile stunning expressed as low output
syndrome without cell death and without apparent signs of infarction or other serum injury
markers. Irreversible reperfusion injury includes apoptosis and necrosis. I/R injury is a
complex process associated with increase of radical, oxidant and cytokines production,
complement and neutrophil activation and endothelial activation leading to microvascular
dysfunction and deterioration of coronary flow reserve. In the hypoxic heart increase
anaerobic lactate production, K+ efflux and membrane depolarization. The intracellular Na+
concentration rises as a consequence of slow Na+ channels inactivation and the induction of
voltage-gated Na+ channel late current component (late INA). Intracellular Na++ accumulation
enhanced activity of reversed-mode Na+-Ca++ exchanger causing intracellular Ca++ overload and
ventricular dysfunction. Therefore inhibition of late INA has been shown to be
cardioprotective. Ranolazine, an FDA-approval antianginal and anti-ischemic agent, high
selective blocker of late INA, inhibits the late sodium current in myocardial ischemia,
decreases Na+ and Ca2+ overload and improves left ventricular function in experimental animal
models. For this reason it was also adjuncted to cardioplegia improving diastolic function in
isolate Langerdoff-perfused rat hearts. The authors test the hypothesis that ranolazine
improve myocardical protection in patients undergoing coronary artery surgery with
cardiopulmonary by-pass (CPB).