Attenuation of acute systemic inflammatory response after valve surgery

Abstract

Background: Montelukast is a selective cysteinyl-leukotriene1 (CysLT1) receptor antagonist. In recent years, several investigations have shown that montelukast possesses both secondary anti-inflammatory activities and antioxidant effects. Hence this study aimed to determine the possible protective effect of montelukast in myocardial ischemia reperfusion injury induced by cardiopulmonary bypass during valve replacement surgery. Patients and methods: A total of 60 patients with valvular disease undergoing elective valve surgery were enrolled in a randomized, single-blind clinical trial. These patients were subdivided into two main groups: Group 1 (montelukast-treated group) consisted of 30 patients who underwent valve surgery; they were given montelukast sodium (10 mg tab) at bedtime for 3 days before surgery. Group 2 (control group) consisted of 30 patients who underwent valve surgery without taking montelukast. For each group, blood samples were collected at the following times: T0, after anesthesia; T1, before aortic cross cl T2, after aortic cross cl and T3, 24 hours after surgery. The inflammatory biomarkers TNF-α, IL-6, α2 macroglobulin/Creatinine ratio, CTnI and ALT were determined. For each group, an echo study was undertaken to determine the ejection fraction (EF) before surgery and three months after surgery. Results: Concentrations of TNF-α, IL-6, α2 macroglobulin/ Creatinine ratio, CTnI, and ALT were significantly higher (P < 0.05) in the control group than in the montelukast-treated group at different sampling times. There was no significant difference in EF between the two groups before surgery, but EF was significantly higher (p < 0.05) in the montelukast-treated group than in the control group after surgery. Conclusion: Montelukast treatment is beneficial to patients who normally undergo a cardiopulmonary bypass during valve replacement surgery.