Cardioprotection with levocarnitine intracoronary administration during percutaneous coronary interventions

Abstract

Currently, the number of percutaneous coronary interventions (PCI) performed in acute and chronic forms of coronary heart disease continues to grow: every year their number reaches at least 5,000,000 worldwide, and more than 200,000 of them in Russia. The main causes of postoperative mortality are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium from ischemia/reperfusion under conditions of balloon expansion and stenting of the affected coronary arteries. The review presents experimental and clinical literature data on the successful use of levocarnitine for cardioprotection in patients with various forms of coronary heart disease and patients with chronic heart failure, both with intravenous administration and as part of a cardioplegic solution during heart surgery. The intracoronary route of administration of levocarnitine solution during PCI in high-risk patients (elderly and senile patients, with multivessel lesions of the coronary bed, difficulties in conducting the intervention) is substantiated. The description of two clinical cases of the use of the technique in elderly patients with acute forms of coronary heart disease with multivessel lesion is given. The postoperative period proceeded without complications with smooth dynamics of biomarkers (troponin I, total creatinephosphokinase, MB-fraction of creatinephosphokinase, lactate dehydrogenase), ischemic ECG shifts were little pronounced. The expected results of the application of the technique are a reduction in intraoperative and postoperative complications of ischemia/ reperfusion and an increase in the effectiveness of the clinical results of PCI in high-risk patients.