This study aims to confirm the safety and efficacy of diazoxide as an additive to hyperkalemic cardioplegia in patients undergoing cardiac surgery with cardiopulmonary bypass. The investigators hypothesize that diazoxide combined with hyperkalemic cardioplegia provides superior myocardial protection and reduced myocardial stunning compared with standard cardioplegia alone. The investigators will randomize 30 patients in a 2:1 fashion to treatment vs control. Safety will be assessed by comparing mean arterial blood pressure measurements, glucose levels and incidence of adverse events between the two groups. Efficacy will be assessed by comparing right and left ventricular function in pre-operative vs post-operative transesophageal echocardiograms, need for mechanical circulatory support, ease of separation from bypass and Vasoactive Inotrope Score (VIS) between the two groups. The information gained could pave the way for the use of Katp (Potassium-atp) channel openers to prevent stunning, improve patient outcomes, and reduce health care costs related to myocardial stunning that requires inotropic and mechanical support following cardiac surgery.
This is a randomized blinded Phase I clinical trial. Thirty patients total will be randomized on a 2:1 basis to treatment (IV Diazoxide added to cardioplegia) vs control (cardioplegia alone). Diazoxide will be added to the first dose of cardioplegia only. Subsequent doses of cardioplegia will not contain additives.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
500 micromoles added to one liter of cardioplegia
Placebo added to one liter of cardioplegia
Johns Hopkins Hospital
Baltimore, Maryland, United States
Safety as assessed by mean change in blood pressure
Mean blood pressure measurements in mmHg.
Time frame: From first dose of cardioplegia through 24 hours post operatively
Safety as assessed by change in blood glucose levels
Blood glucose levels in mg/dl.
Time frame: From first dose of cardioplegia through 48 hours post operatively
Safety as assessed by incidence of adverse events
Safety will be assessed by total number of adverse events.
Time frame: From first dose of cardioplegia through 7 days post operatively or discharge, whichever comes first
Efficacy as assessed by change in ejection fraction
Comparison of right and left ventricular function (measured as a percentage) on pre and post operative Transesophageal echocardiograms
Time frame: Day of surgery (pre and post surgery)
Efficacy as assessed by use of mechanical circulatory support
Incidence of mechanical circulatory support use will be used in the assessment of efficacy.
Time frame: 48 hours post operatively
Efficacy as assessed by change in Vasoactive Inotropic Score (VIS)
Comparison of VIS Score with values from 0 to \>45, with lower scores indicating medication efficacy (0e5, \>5e15, \>15e30, \>30e45, and \>45 points).
Time frame: 0, 24, 48 and 72 hours post operatively
Efficacy as assessed by time to separate from Cardiopulmonary Bypass (CPB)
From time of first turn down of CPB to CPB end time measured in minutes.
Time frame: Day of surgery
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