A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery

2011 ◽  
Vol 21 (3) ◽  
pp. 266-270 ◽  
Author(s):  
Wanjun Luo ◽  
Ming Zhu ◽  
Rimao Huang ◽  
Yangde Zhang
Keyword(s):  
Creatine Kinase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Myocardial Protection ◽  
Septal Defect ◽  
Troponin I ◽  
Control Group ◽  
Conditioning Group ◽  
Cardioplegic Arrest ◽  
Creatine Kinase Mb

AbstractBackgroundRemote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.MethodsWe randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.ResultsMean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).ConclusionsOur study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

2018 ◽  
Vol 26 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Debasish Panigrahi ◽  
Saibal Roychowdhury ◽  
Rahul Guhabiswas ◽  
Emmanuel Rupert ◽  
Mrinalendu Das ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Creatine Kinase ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Myocardial Protection ◽  
Troponin I ◽  
Blood Cardioplegia ◽  
Cardioplegia Solution ◽  
Creatine Kinase Mb

Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements. Results Demographic characteristics, cardiopulmonary bypass time, and aortic crossclamp time were comparable in the 2 groups. Time-related changes in troponin I and creatine kinase-MB were similar in both groups. Statistically significant differences were seen in total cardioplegia volume requirement ( p < 0.0001), number of cardioplegia doses given ( p < 0.0001), packed red cell volume usage during cardiopulmonary bypass ( p < 0.02), and time taken to restore spontaneous regular rhythm ( p < 0.0001). Vasoactive-inotropic scores on transfer to the intensive care unit ( p < 0.040) and at 24 h ( p < 0.030) were significantly lower in the del Nido group. Duration of mechanical ventilation, intensive care unit stay, and hospital stay were comparable in the 2 groups. Conclusions Our results show that del Nido cardioplegia solution is as safe as conventional blood cardioplegia. Moreover, it provides the benefits of reduced dose requirement, lower consumption of allogenic blood on cardiopulmonary bypass, quicker resumption of spontaneous regular cardiac rhythm, and less inotropic support requirement on transfer to the intensive care unit and at 24 h, compared to conventional blood cardioplegia.

Does cardioplegia leave room for postconditioning in paediatric cardiac surgery?

2008 ◽  
Vol 18 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Wanjun Luo ◽  
Bei Li ◽  
Guoqiang Lin ◽  
Ri Chen ◽  
Rimao Huang
Keyword(s):  
Creatine Kinase ◽  
Cardiac Surgery ◽  
Myocardial Protection ◽  
Troponin I ◽  
Control Treatment ◽  
Cardioplegic Arrest ◽  
Cardiac Intervention ◽  
Creatine Kinase Mb ◽  
Cold Blood ◽  
Percutaneous Cardiac Intervention

AbstractBackgroundPostconditioning by brief episodes of ischaemia performed just at the time of reperfusion have been shown to reduce the size of infarcts in animal models, and in the clinical setting of percutaneous cardiac intervention. The clinical applicability of postconditioning in cardiac surgery remains to be determined. We investigated the effect of postconditioning on myocardial protection in children undergoing cardiac surgery.MethodsWe randomly assigned 40 patients scheduled for surgical correction of congenitally malformed hearts under cold blood cardioplegic arrest to postconditioning or control treatment. Postconditioning was performed by two cycles of 30 seconds ischaemia and 30 seconds reperfusion using aortic reclamping, and declamping started 30 seconds after cardioplegic arrest. We assayed creatine kinase-MB, troponin I, transcardiac release of lactate and neutrophil counts.ResultsThe types of procedure, age, bypass and aortic cross-clamping times were similar in both groups. The postoperative peaks of creatine kinase-MB and troponin I were lower after aortic de-clamping in the postconditioned patients compared with their controls (128 ± 48 units per liter as opposed to 199 ± 79 units per liter, p = 0.016, and 0.34 ± 0.21 nanograms per milliliter as opposed to 0.61 ± 0.53 nanograms per milliliter, p = 0.05), with reduced inotropic scores in those submitted to postconditioning compared with their controls (4.8 ± 3.1 versus 2.3 ± 1.5, p = 0.036). Transcardiac release of lactate was reduced in the postconditioned patients compared with their controls (0.10 ± 0.27 as opposed to 0.37 ± 0.43 millimols per liter, p = 0.048). No differences between groups were found for transcardiac neutrophil count during reperfusion (10.8 ± 6.3% for postconditioning versus 14.0 ± 8.7% for controls, p = 0.48).ConclusionsOur study demonstrates that postconditioning may protect the myocardium of children undergoing cold blood cardioplegic arrest. These data support the need for a larger clinical trial of postconditiong in children undergoing cardiac surgery.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy

Perfusion ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Micaela De Palo ◽  
Pietro Guida ◽  
Florinda Mastro ◽  
Daniela Nanna ◽  
Teresa A.P. Quagliara ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Troponin I ◽  
Minimally Invasive Cardiac Surgery ◽  
Enzyme Release ◽  
Time Duration ◽  
Creatine Kinase Mb ◽  
Cold Blood ◽  
Mini Thoracotomy

Background: Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS. Aim: The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS. Method: We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery. Results: The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay. Conclusions: Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.

Propofol Is Cardioprotective in a Clinically Relevant Model of Normothermic Blood Cardioplegic Arrest and Cardiopulmonary Bypass

2005 ◽  
Vol 230 (6) ◽  
pp. 413-420 ◽  
Author(s):  
Kelvin H. H. Lim ◽  
Andrew P. Halestrap ◽  
Gianni D. Angelini ◽  
M.-Saadeh Suleiman
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Function ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Ischemia Reperfusion ◽  
Cardiac Troponin I ◽  
Cardioplegic Arrest ◽  
Relevant Model ◽  
Blood Cardioplegia

The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment ( n = 8) and control ( n =12) groups, were surgically prepared for cardiopulmonary bypass (CPB) and cardioplegic arrest. Doses of warm blood cardioplegia were delivered at 15-min intervals during a 60-min aortic cross-clamped period. Propofol was continuously infused for the duration of CPB and was therefore present in blood cardioplegia. Myocardial biopsies were collected before, at the end of cardioplegic arrest, and 20 mins after the release of the aortic cross-clamp. Hemodynamic parameters were monitored and blood samples collected for cardiac troponin I measurements. Propofol infusion during CPB and before ischemia did not alter cardiac function or myocardial metabolism. Propofol treatment attenuated the changes in myocardial tissue levels of adenine nucleotides, lactate, and amino acids during ischemia and reduced cardiac troponin I release on reperfusion. Propofol treatment reduced measurable hemodynamic dysfunction after cardioplegic arrest when compared to untreated controls. In conclusion, propofol protects the heart from ischemia-reperfusion injury in a clinically relevant experimental model. Propofol may therefore be a useful adjunct to cardioplegic solutions as well as being an appropriate anesthetic for cardiac surgery.

Effect of statin on perioperative myocardial injury in isolated valve surgery

2020 ◽  
pp. 021849232097451
Author(s):  
Atul Kaushik ◽  
Aditya Kapoor ◽  
Surendra Kumar Agarwal ◽  
Shantanu Pande ◽  
Shiridhar Kashyap ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Cardiopulmonary Bypass ◽  
Brain Natriuretic Peptide ◽  
Valve Replacement ◽  
Natriuretic Peptide ◽  
Myocardial Injury ◽  
Troponin I ◽  
Ischemia Reperfusion ◽  
Area Under The Curve ◽  
Creatine Kinase Mb

Background Statins have known pleiotropic effects that confer protection from ischemia-reperfusion injury. Because cardiopulmonary bypass is a potentially reversible ischemia-reperfusion sequence, we aimed to assess whether statin loading could help to limit myocardial injury in patients undergoing isolated heart valve replacement under cardiopulmonary bypass. Methods One hundred patients with rheumatic valvular heart disease undergoing valve replacement received either a loading dose of rosuvastatin (40 mg initiated 7 days before surgery; loaded group) or no statins (non-loaded group). Cardiac troponin I, creatine kinase MB, and brain natriuretic peptide were measured at 8, 24, and 48 hours postoperatively. The primary endpoint was the extent of perioperative myocardial injury measured by the area under the curve for each biomarker. Results Despite similar baseline levels, all biomarkers at 8, 24, and 48 h were significantly lower in the loaded group. The area under the curve of each biomarker was significantly lower in the loaded group than in the non-loaded group (troponin I: 31.43 vs. 77.21 ng·h·mL−1, creatine kinase MB 309.31 vs. 429.12 ng·h·mL−1, brain natriuretic peptide 5176.11 vs. 16119.31 pg·h·mL−1, all p < 0.001). The mean changes from baseline to peak levels were also significantly lower in the loaded group. The loaded group had a shorter hospital stay but no significant difference was seen in ventilator time, inotrope time, aortic crossclamp time, cardiopulmonary bypass time, or intensive care unit stay. Conclusion In patients undergoing valve replacement, high-dose statin loading before surgery had a favorable impact on the release kinetics of various cardiac biomarkers.

scholarly journals Cardiac biomarkers and blood metabolites in cows with clinical ketosis

2019 ◽  
Vol 40 (6Supl3) ◽  
pp. 3525 ◽  
Author(s):  
Gliére Silmara Leite Soares ◽  
Ana Clara Sarzedas Ribeiro ◽  
Jobson Filipe de Paula Cajueiro ◽  
Rodolfo José Cavalcanti Souto ◽  
Emanuel Felipe de Oliveira Filho ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Dairy Cows ◽  
Troponin I ◽  
Pearson Correlation ◽  
Clinical Signs ◽  
Central Nervous System Involvement ◽  
Cardiac Biomarkers ◽  
Control Group ◽  
Stage Of Lactation ◽  
Creatine Kinase Mb

The increase in energy imbalance at the beginning of lactation leads to metabolic disorders, especially clinical ketosis, in highly productive dairy cows. The objective of this study is to evaluate the clinical characteristics, biochemical parameters, and cardiac biomarkers creatine kinase MB isoenzyme (CK-MB) and cardiac troponin I (cTnI) of 15 cows diagnosed with clinical ketosis treated at the Bovine Clinic of Garanhuns at the Federal Rural University of Pernambuco. Nine of the 15 cows were diagnosed with primary ketosis and six had concomitant diseases, including left abomasal displacement, metritis, pneumonia, and renal failure. The observed clinical signs were non-specific and included decreased appetite and milk production and weight loss. Approximately 53% of the animals had central nervous system involvement. For biochemical evaluation, 15 high-production healthy dairy cows at the initial stage of lactation served as the control group. The data were subjected to analysis of variance for simultaneous comparison between two means allowing testing the hypothesis on the means of the different groups and subjected to Pearson correlation at a level of significance of 5%. The levels of ?-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), glucose, fructosamine, total protein, albumin, creatinine, aspartate aminotransferase, creatine kinase, CK-MB, and cTnI were higher in the group with ketosis. The diseased animals presented changes in glycemia, reduction in tissue sensitivity to insulin, and a lower RQUICKI-BHB index, especially hyperglycemic animals. The increase in the levels of cardiac biomarkers suggests the occurrence of myocardial injury associated with bovine ketosis.

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