Role of terminal warm blood cardioplegia in complex congenital heart surgery

2018 ◽  
Vol 26 (3) ◽  
pp. 196-202 ◽  
Author(s):  
Pribadi Wiranda Busro ◽  
Harvey Romolo ◽  
Sudigdo Sastroasmoro ◽  
Jusuf Rachmat ◽  
Mohammad Sadikin ◽  
...  
Keyword(s):  
Treatment Group ◽  
Myocardial Protection ◽  
Caspase 3 ◽  
Heart Surgery ◽  
Troponin I ◽  
Congenital Heart Surgery ◽  
Control Group ◽  
Blood Cardioplegia ◽  
Warm Blood ◽  
Warm Blood Cardioplegia

Introduction Myocardial protection is vital to ensure successful open heart surgery. Cardioplegic solution is one method to achieve good myocardial protection. Inevitably, ischemia-reperfusion injury occurs with aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a frequently used cardioplegia for complex congenital heart surgery. We postulated that addition of terminal warm blood cardioplegia before removal of the aortic crossclamp might improve myocardial protection. Method A randomized controlled trial was conducted on 109 cyanotic patients aged, 1 to 5 years who underwent complex biventricular repair. They were divided into a control group of 55 patients who had histidine-tryptophan-ketoglutarate only and a treatment group of 54 who had histidine-tryptophan-ketoglutarate with terminal warm blood cardioplegia. Endpoints were clinical parameters, troponin I levels, and caspase-3 as an apoptosis marker. Results The incidence of low cardiac output syndrome was 34%, with no significant difference between groups (35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment group was lower compared to the control group (36% vs. 12%, p = 0.005). Troponin I and caspase-3 results did not show any significant differences between groups. For cases with Aristotle score ≥ 10, weak expression of caspase-3 in the treatment group post-cardiopulmonary bypass was lower compared to the control group. Conclusion For complex congenital cardiac surgery, the addition of terminal warm blood cardioplegia does not significantly improve postoperative clinical or metabolic markers.

Intermittent Antegrade Warm Blood Cardioplegia: What Is Next?

2019 ◽  
Vol 68 (03) ◽  
pp. 232-234
Author(s):  
Antonio Maria Calafiore ◽  
Piero Pelini ◽  
Massimilliano Foschi ◽  
Michele Di Mauro
Keyword(s):  
Surgical Procedure ◽  
Myocardial Protection ◽  
Heart Surgery ◽  
Radical Change ◽  
Blood Cardioplegia ◽  
Scientific World ◽  
Warm Blood ◽  
Warm Blood Cardioplegia ◽  
Warm Heart Surgery ◽  
Over Time

AbstractThe introduction of warm heart surgery was a radical change in the concept of myocardial protection. In 1992, we applied a protocol for intermittent antegrade warm blood cardioplegia (CPL), which acquired some popularity for its simplicity and effectiveness. The possibility to deliver the warm blood CPL intermittently using the antegrade route attracted the attention of the scientific world, as the surgical procedure was less complicated. In this report, our aim is to focus on the changes that the protocol underwent over time and the reasons why these changes were made.

scholarly journals Effects of Del Nido and Terminal Warm Blood Cardioplegia on Myocardial Protection and Rhythm in Isolated CABG Patients

2021 ◽  
Vol 24 (5) ◽  
pp. E808-E813
Author(s):  
Kemal Karaarslan ◽  
Burcin Abud
Keyword(s):  
Myocardial Protection ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Coronary Bypass ◽  
Ischemic Time ◽  
Blood Cardioplegia ◽  
Significant Difference ◽  
Warm Blood ◽  
Warm Blood Cardioplegia ◽  
Cabg Patients

Objective: To investigate the effect of using del Nido cardioplegia+terminal hot-shot blood cardioplegia on myocardial protection and rhythm in isolated coronary bypass patients. Material and methods: A total of 122 patients were given cold (+4-8C') del Nido cardioplegia antegrade and evaluated. Del Nido+terminal warm blood cardioplegia (TWBCP) was applied to 63 patients out of 122 patients, while del Nido cardioplegia alone was applied to the other 59 patients. The preoperative and postoperative data of the patients were recorded and compared. Results: There was a significant statistical difference between the groups, in terms of volume with more cardioplegia in the del Nido+terminal warm blood cardioplegia group. Although there was no significant difference between cardiac arrest times in both groups, a statistically significant difference was found in the del Nido+terminal warm blood cardioplegia group in the starting to work time of the heart. No difference found between the groups regarding myocardial preservation. Conclusions: We can add a return to spontaneous sinus rhythm to the advantages of terminal warm blood cardioplegia and del Nido cardioplegia in literature. We think it would be a good strategy to extend the safe ischemic time limit of del Nido to 120 minutes with a terminal warm blood cardioplegia. It seems that cardioplegia techniques that will be developed by adding the successful and superior results of crystalloid cardioplegia applications, such as single dose del Nido in various open heart surgery operations and the superior myocardial return effects of terminal warm blood cardioplegia, will be used routinely in the future.

scholarly journals COMPARISON STUDY: INTERMITTENT ANTIGRADE WARM CARDIOPLEGIA VERSUS ANTIGRADE COLD INTERMITTENT BLOOD CARDIOPLEGIA FOR MYOCARDIAL PROTECTION DURING ELECTIVE ON PUMP CORONARY ARTERY BYPASS GRAFTING IN EARLY POST-OPERATIVE PERIOD

2020 ◽  
Vol 8 (10) ◽  
pp. 612-623
Author(s):  
Mahmoud F. El-Safty ◽  
◽  
Hazem Gamal Bakr ◽  
Mohamed Abd El-Hady ◽  
Yahia Mahmoud
Keyword(s):  
Myocardial Protection ◽  
Troponin I ◽  
Myocardial Metabolism ◽  
Artery Bypass ◽  
Cool Temperature ◽  
Blood Cardioplegia ◽  
Cold Blood ◽  
Warm Blood ◽  
Warm Blood Cardioplegia ◽  
Cold Blood Cardioplegia

Background: Defending the heart against potential damage during cross-clamping is the most important and vital step to ensuring a successful surgical outcome(1). The creation of cardioplegia solutions was one of the major advances in cardiac surgery that allowed surgeons to conduct complicated surgical procedures to avoid myocardial injury (14). Treating cardioplegia at a cool temperature would be a significant factor in lowering myocardial metabolism. However, the reduction in myocardial metabolism due to hypothermia, compared with that achieved by diastolic arrest, is usually very negligible. Since Normothermias enzymatic and cellular processes work better (7). Owing to the propensity of the heart to resume electrical operation during normothermia, however, this must be administered consistently or only with short interruptions (4). Terminal warm blood cardioplegia (hot shot) is normally done just before the elimination of the aortic cross-clamp since it has been demonstrated that myocardial metabolism is increasing (23). Methods: A prospective controlled randomised study (200 hundred patients aged 40 to 65 years of both sexes underwent elective CABG pump surgery) will be included. They will be divided into three groups of patients: Group I:includes 100 Patients who received intermittent cold blood cardioplegia. Group II:includes 100 Patients who received intermittent warm blood cardioplegia with controlled reperfusion for 3 minutes before aortic unclamping. Study made from January, 2019 to August, 2020, at National Heart Institute.All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: We hypothesized that in our patient cohort, warm blood cardioplegia could be as successful as or even better than the conventional antegrade cold blood cardioplegia. Patients were randomised into two similar blocks, each of which consisted of 100 patients, each of whom obtained one of the two cardioplegic solutions. Our analysis did not indicate a statistically important difference in the post-operative release of myocardial biomarkers (Troponin I) & CK in both classes. This finding did not significantly reflect the clinical outcome of our patient, which may indicate similar myocardial protection in primary low-risk CABG patients for both cold and warm blood cardioplegia. Conclusion: During the time of cardiac arrest, both methods tend to enable an equal and adequate approach for myocardial defence. To attain improved myocardial defence, warm blood cardioplegia needs a shorter administration interval. Therefore, the choice between one type of cardioplegia and the other remains at the discretion of the surgeon. The statistically minor variation found in the release of myocardial enzymes did not translate into distinct clinical results.

scholarly journals Continuous Warm Blood Cardioplegia for Congenital Heart Surgery.

1998 ◽  
Vol 18 (3) ◽  
pp. 259-264
Author(s):  
Koui KA ◽  
Kouichi HIROKI ◽  
Kenji ONO ◽  
Ryouko NAMATAME ◽  
Takanori HUJIHARA ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Blood Cardioplegia ◽  
Warm Blood ◽  
Warm Blood Cardioplegia

Retrograde continuous warm blood cardioplegia: A new concept in myocardial protection

1991 ◽  
Vol 51 (2) ◽  
pp. 245-247 ◽  
Author(s):  
Tomas A. Salerno ◽  
James P. Houck ◽  
Carlos A.M. Barrozo ◽  
Anthony Panos ◽  
George T. Christakis ◽  
...  
Keyword(s):  
Myocardial Protection ◽  
Blood Cardioplegia ◽  
Warm Blood ◽  
Warm Blood Cardioplegia

scholarly journals Warm Blood Cardioplegia for Myocardial Protection: Concepts and Controversies

2020 ◽  
Vol 47 (2) ◽  
pp. 108-116
Author(s):  
Taylor M. James ◽  
Marcos Nores ◽  
John A. Rousou ◽  
Nicole Lin ◽  
Sotiris C. Stamou
Keyword(s):  
Experimental Data ◽  
Cardiopulmonary Bypass ◽  
Clinical Research ◽  
Myocardial Protection ◽  
Blood Cardioplegia ◽  
Warm Blood ◽  
History Of ◽  
Warm Blood Cardioplegia

Warm blood cardioplegia has been an established cardioplegic method since the 1990s, yet it remains controversial in regard to myocardial protection. This review will describe the physiologic and technical concepts behind warm blood cardioplegia, as well as outline the current basic and clinical research that evaluates its usefulness. Controversies regarding this technique will also be reviewed. A long history of experimental data indicates that warm blood cardioplegia is safe and effective and thus suitable myocardial protection during cardiopulmonary bypass surgeries.

scholarly journals Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Zhigang Qin ◽  
Younian Xu
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Treatment Group ◽  
Cardiac Function ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Control Group ◽  
Muscle Rigidity ◽  
Significant Difference

In this study, we have investigated feasibility of remifentanil and sufentanil anesthesia in children with congenital heart disease surgery and its effects on cardiac function and serological parameters. For this purpose, a retrospective study was conducted on 120 children with congenital heart disease who underwent repair of ventricular septum or atrial septum in our hospital, specifically from January 2016 to January 2018, and 60 patients in each group were randomly divided into the control and treatment groups, respectively. The control group was anesthetized with sufentanil, and the treatment group was anesthetized with remifentanil. The heart function, serological indexes, and adverse reactions were observed and compared. We have observed that there was no significant difference in HR levels between these groups ( P > 0.05 ), but SDP and DBP values of the two groups were decreased after anesthetic induction ( P < 0.05 ). ACH, cortisol, and lactic acid in the treatment group were significantly lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). The incidence of bradycardia, nausea and vomiting, hypotension, muscle rigidity, and respiratory depression in the treatment group was 16.67% lower than that in the control group ( P < 0.05 ). Remifentanil has less influence on hemodynamics and a better analgesic effect than fentanyl in inhibiting stress response in congenital heart surgery, which provides reference and basis for children congenital heart surgery.

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