scholarly journals Cardioplegia Application with A Hand-Squeezed Cardioplegia Bag. Is It Safe?

2021 ◽  
Vol 24 (4) ◽  
pp. E619-E623
Author(s):  
Kemal Karaarslan ◽  
Burcin Abud ◽  
Mustafa Karacelik ◽  
Bilen C
Keyword(s):  
Myocardial Protection ◽  
Statistical Difference ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Blood Cardioplegia ◽  
Heart Lung Machine ◽  
Group A ◽  
Antegrade Cardioplegia ◽  
Group B ◽  
Lung Machine

Objectives: Cardioplegia solutions have a role not only in arresting the heart but also in protecting the myocardium from ischemia. While antegrade cardioplegia is given by the heart-lung machine in many centers, it is given by a hand-squeezed bag in very few centers. The pressure of cardioplegia given antegrade from the heart-lung machine is certain (60-90 mmHg). The pressure applied in the cardioplegia method, which is given antegrade with a hand-squeezed bag, is uncertain and variable. We compared the antegrade cardioplegia method applied with a hand-squeezed bag with the antegrade cardioplegia method applied with a roller pump from the heart-lung machine in terms of protecting the myocardium from ischemia. Methods: Seventy-six patients who did not have an acute myocardial infarction, had normal preoperative cardiac marker (troponin and CK-MB) values, did not undergo redo open heart surgery, had an ejection fraction of 50% and above, and underwent elective two or three-vessel isolated coronary artery bypass surgery were evaluated. While tepid (30-32°C) blood cardioplegia was administered antegrade to 33 patients (Group A) with a hand-squeezed bag, the other 34 patients (Group B) received tepid (30-32°C) antegrade blood cardioplegia from the heart-lung machine. The perioperative and postoperative data of the patients were recorded and compared. To evaluate myocardial damage, postoperative cardiac markers and echocardiography data were evaluated and compared at the fourth hour after the cross-clamp was removed in both groups. Results: When evaluated in terms of preoperative demographic data, preoperative mean EF values and intraoperative data, there was no statistical difference between both groups. When we evaluated in terms of myocardial protection, the mean TnT level was 4.31 ± 1.95 at the 4th hour in Group A and 3.91 ± 1.69 in Group B. Mean 4th hour CK-MB level was 40.84 ± 9.07 in Group A and 38.56 ± 8.07 in Group B. Mean change in EF (%) was -4.09 ± 4.41 in Group A and 3.53 ± 4.53 in Group B. In line with the current data when we evaluated in terms of myocardial protection, we found that there is no statistical difference between the two groups (P = 0.373; P = 0.158; P = 0.523). There was no statistical difference between both groups, in terms of postoperative arrhythmias. None of the patients died, and no patients required an intra-aortic balloon pump. Results: As a result of our study, cardioplegia administration with a certain constant pressure from the roller pump and hand-squeezed bag with uncertain pressure does not make a difference, in terms of myocardial protection. We think that the content and amount of cardioplegia and the preferred time for repeated cardioplegia applications are more important for the protection of the myocardium. Methods: 76 patients who did not have an acute myocardial infarction, had normal preoperative cardiac marker (troponin and CK-MB) values, did not undergo redo open heart surgery, had an ejection fraction of 50% and above, and underwent elective two or three-vessel isolated coronary artery bypass surgery were evaluated. While tepid(30-32 ° C) blood cardioplegia was administered antegrade to 33 patients(Group A) with a hand-squeezed bag, the other 34 patients(Group B) received tepid(30-32 °C) antegrade blood cardioplegia from the heart-lung machine. The perioperative and postoperative data of the patients were recorded and compared. To evaluate myocardial damage, postoperative cardiac markers and echocardiography data were evaluated and compared at the fourth hour after the cross-clamp was removed in both groups. Results: When evaluated in terms of preoperative demographic data, preoperative mean EF values and intraoperative data there was no statistical difference between both groups. When we evaluated in terms of myocardial protection, the mean TnT level was 4.31 ± 1.95 at the 4th hour in group A and 3.91 ± 1.69 in group B. Mean 4th hour CK-MB level was 40.84 ± 9.07 in group A and 38.56 ± 8.07 in group B. Mean change in EF (%) was -4.09 ± 4.41 in group A and 3.53 ± 4.53 in group B. In line with the current data when we evaluated in terms of myocardial protection; we found that there is no statistical difference between the two groups (p = 0.373; p = 0.158; p = 0.523). There was no statistical difference between both groups in terms of postoperative arrhythmia's. None of the patients died and none of the patients required an intra-aortic balloon pump.

scholarly journals HYPOTHERMIC ANALGESIA FOR OPEN HEART SURGERY WITH THE HEART-LUNG MACHINE

1959 ◽  
Vol 37 (2) ◽  
pp. 184-189 ◽  
Author(s):  
William W. Musicant ◽  
Reuben R. Lewis ◽  
Belmont S. Musicant ◽  
Robert M. Anderson ◽  
Jerome Harold Kay
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Heart Lung Machine ◽  
Lung Machine

scholarly journals Novel Straight Type Aortic Cannula with Spiral Flow Inducing Design

2015 ◽  
Vol 773-774 ◽  
pp. 69-74 ◽  
Author(s):  
Nofrizalidris Darlis ◽  
Nadia Shaira Shafii ◽  
Jeswant Dillon ◽  
Kahar Osman ◽  
Ahmad Zahran Md Khudzari
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Ascending Aorta ◽  
Spiral Flow ◽  
Heart Lung Machine ◽  
Atherosclerosis Development ◽  
Aortic Cannula ◽  
Major Factors ◽  
Novel Design ◽  
Lung Machine

Aortic cannula is one of major factors leading to adverse events such as thrombosis and atherosclerosis development during open heart surgery. This is due to oxygenated blood outflow with high velocity jet from heart lung machine when exiting the cannula tip into ascending aorta. It was discovered, and validated by several researchers that blood flow out of the left ventricle into the aorta is spiral in nature. In this study, a novel design in which internal profile of the cannula was made to induce spiral flow were tested by way of numerical simulation, and compared against existing commercial cannula. Three designs were tested, which differed in number of groove employed. Among the cannula model designs, cannula design with 4 grooves yielded the lowest value of maximum wall shear stress at testing tube with 3.778 Pa and highest value of area weighted helicity density at 40 mm from cannula tips with 11.829 m/s2. Overall, spiral cannula models were showed highly potential in inducing spiral flow, and also the effect on blood hemolysis is acceptable.

scholarly journals Open Cardiac Compression in the Postoperative Cardiac Intensive Care Unit

1989 ◽  
Vol 17 (2) ◽  
pp. 129-135 ◽  
Author(s):  
J. Raman ◽  
R. F. Saldanha ◽  
J. M. Branch ◽  
D. S. Esmore ◽  
P. M. Spratt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Functional Class ◽  
External Compression ◽  
Cardiac Compression ◽  
Group A ◽  
Cardiac Intensive Care ◽  
Group B

Thirty-nine patients required heroic resuscitative measures for sudden hypotension and cardiac arrest in the first 72 hours following cardiac surgery between January 1, 1984 and May 31, 1988. Emergency sternotomy with open cardiac compression was performed in twenty-four of these patients when external cardiac compression failed. These were categorised as Group A. Group B comprised the fifteen patients in whom resuscitation was entirely by means of external compression and adjuvant measures. Survival with NYHA Functional Class I and II status was noted in 75% of patients in Group A, compared with 20% in Group B (P <0.002). Emergency sternotomy with open cardiac compression is an effective way of resuscitating patients in the intensive care unit in the first few days following open heart surgery.

Normothemic Continuous Blood Cardioplegia Improves Electrophysiologic Recovery after Open Heart Surgery

1996 ◽  
Vol 84 (6) ◽  
pp. 1298-1306 ◽  
Author(s):  
Yaacov Gozal ◽  
Lucio Glantz ◽  
Myron H. Luria ◽  
Eli Milgalter ◽  
Dov Shimon ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Fibrillation ◽  
Myocardial Protection ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Blood Concentrations ◽  
Preferred Temperature ◽  
Blood Cardioplegia ◽  
Normothermic Group

Background Myocardial protection during open heart surgery is based on administration of oxygenated blood cardioplegia, the preferred temperature of which is still under debate. The current randomized study was designed to prospectively evaluate the quality of myocardial protection and the functional recovery of the heart with either normothermic (group N) or hypothermic (group H) oxygenated blood cardioplegia. Methods Under continuous electrocardiographic Holter monitoring, 42 patients were randomly scheduled to receive either normothermic (33.5 degrees C) or hypothermic (10 degrees C) cardioplegia solutions during coronary bypass grafting surgery. Blood samples for creatinine phosphokinase, creatinine phosphokinase-MB, lactate, epinephrine, and norepinephrine were withdrawn during cardiopulmonary bypass via a coronary sinus cannula. Results Active cooling in group H on initiation of cardiopulmonary bypass was characterized by transition through ventricular fibrillation in 75% of patients, whereas in group N atrial fibrillation occurred in 65% of patients. On myocardial reperfusion, sinus rhythm spontaneously resumed in 95% of group N patients compared to 25% in group H (P = 0.0003). In the latter, 75% of patients developed ventricular fibrillation often followed by complete atrioventricular block, which necessitated temporary pacing for a mean duration of 168 +/- 32 min. Both groups showed a similar incidence of intraventricular block and ST segment changes. However, the incidence of ventricular premature beats in the first 16 h after cardiopulmonary bypass was significantly greater in group H (P &lt; 0.05), 20 +/- 26/h, compared to 3 +/- 5/h in group N. Blood concentrations of lactate, creatinine phosphokinase, epinephrine, and norepinephrine increased gradually during the operation, but the differences between the groups were not significant. Conclusions The current prospective human study suggests that the increased susceptibility for ventricular fibrillation and dysrhythmia, and the delayed recovery of the conduction system after hypothermic myocardial protection, are related to temperature-induced changes in vital cellular functions of the conduction tissue in the postischemic period. Both cardioplegic methods provide adequate myocardial protection but normothermic oxygenated blood cardioplegia may accelerate recovery of the heart after cardiopulmonary bypass.

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.

Cardioprotection with Adenosine during Coronary Revascularization

2021 ◽  
Vol 13 (2) ◽  
pp. 128-134
Author(s):  
M Rumman Idris ◽  
AM Asif Rahim ◽  
M Kamrul Hasan ◽  
M Rezaul Karim ◽  
Nusrat Jahan ◽  
...  
Keyword(s):  
Myocardial Protection ◽  
Troponin I ◽  
Myocardial Damage ◽  
Cellular Damage ◽  
High Potassium ◽  
Blood Cardioplegia ◽  
Cabg Surgery ◽  
Group A ◽  
Pre Treatment ◽  
Group B

Background: Postoperative cardiac dysfunction is a common cause of mortality and morbidity associated with CABG Surgery. Adenosine enhances tolerance of the myocardium to ischemic arrest. Therefore, the study on adenosine pre-treatment as an adjunct to cardioplegia in patients undergoing CABG will definitely help to provide better myocardial protection for better postoperative outcome. Methods: Quasi experimental study was done in the Department of Cardiac Surgery, NICVD during July 2012 to June 2014 with patients who underwent conventional CABG surgery. Patients were divided in two groups. Group A: Patients received at regular institutional high-potassium ([K+] = 20 mol/ l) cold (12 °C) blood cardioplegia. and Group B: Patients received 250 μg /kg bolus dose of adenosine pre-treatment, which was immediately followed by high-potassium cold (12 °C) blood cardioplegia after clamp-on. Patients were followed up to evaluate the degree of myocardial damage by measuring perioperative Troponin I, amount of inotropic support, time of assisted ventilation, arrhythmia and mortality. Results: Most of the patients in each group belongs to 51-60 years of age range. There was no difference regarding operative parameters in two groups. Time to arrest was significantly shorter in group B compared to group A, indicating that adenosine has the potential to enhance the efficacy of cardioplegic arrest. Plasma level markers of myocardial damage: cardiac Troponin I (cTnI) obtained from serial venous blood samples post-operatively were significantly lower in group B than group A (p<0.05). There was significantly decreased requirement of inotrope in group B during first 24 hrs (p <0.05). Conclusion: Decreased level of cardiac enzymes and lower inotropic requirement suggests that an optimal myocardial protection with less cellular damage is obtained with adenosine pre-treatment as adjunct to cold blood cardioplegia. Cardiovasc. j. 2021; 13(2): 128-134

scholarly journals Clinical Experience of Open-heart Surgery by Means of Hypothermia and Heart-lung Machine

1964 ◽  
Vol 83 (2) ◽  
pp. 146-158 ◽  
Author(s):  
Togo Horiuchi ◽  
Kei Koyamada ◽  
Takeo Honda ◽  
Takeshi Ishitoya ◽  
Yasuhiko Sagawa ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Heart Lung Machine ◽  
Lung Machine

Pioneering Open-Heart Surgery at the University of Minnesota and the Mayo Clinic

2015 ◽  
Author(s):  
W. Bruce Fye
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Open Heart Surgery ◽  
Clinical Use ◽  
Open Heart ◽  
University Of Minnesota ◽  
Heart Lung Machine ◽  
The University ◽  
Lung Machine

During the early 1950s, several dozen surgeons were attempting to develop technologies and techniques that would allow them to operate inside the heart. The challenge was to develop a safe way to temporarily take over the functions of the heart and lungs so the heart could be opened and drained of blood. A surgeon could then see and repair abnormal or damaged structures inside the organ. The first patients were children or adolescents with congenital heart defects that had caused heart failure. Mayo surgeon John Kirklin led a multidisciplinary team in the testing and clinical use of a heart-lung machine that had been refined in Rochester from plans provided by IBM and John Gibbon Jr. of Philadelphia. Although initial mortality was high, experience with the Mayo-Gibbon machine proved that it was possible to operate inside the hearts and save the lives of patients who were destined to die without surgery.

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