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.

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.

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.

scholarly journals Antegrade Intermittent Cold Cardioplegia in Comparison to Antegrade Intermittent Warm Cardioplegia in Heart Valve Surgery

2020 ◽  
Author(s):  
Haitham Abdel-bakey ◽  
Ahmed Elminshawy ◽  
Ahmed Ghoneim ◽  
Ahmed Taha
Keyword(s):  
Heart Valve ◽  
Valve Surgery ◽  
Controlled Study ◽  
Heart Valve Surgery ◽  
Ischemic Time ◽  
Blood Cardioplegia ◽  
Significant Difference ◽  
Warm Blood ◽  
Cold Cardioplegia ◽  
Warm Blood Cardioplegia

Background: The cardioplegic arrest is essential for motionless and bloodless heart valve surgery. The objective of this work was to compare antegrade cold versus warm blood cardioplegia during valve surgery. Methods: This randomized controlled study included 100 patients who had mitral valve surgery. Patients were randomly assigned into two groups; the warm cardioplegic group (n= 50) and the cold cardioplegic group (n= 50). Study endpoints were creatine kinase myocardial band, lactate dehydrogenase, and troponin levels. Results: There was no significant difference in age and sex between groups (p= 0.51 and 0.56, respectively). Cardiopulmonary bypass was significantly longer in the cold group (85.66 ± 22.9 vs. 72.34 ± 25.09 minutes; P= 0.01); however, there was no difference in ischemic time (p= 0.32). The number of DC shocks given for each patient is less in the warm group with a median of 1.5 (range 1-3 times), while in the cold group, the median was 2 (range 2-4 times); p= 0.02. The amount of blood loss was significantly lower among the warm group (645.4 ± 464.93 ml vs. 404 ± 252.7 P< 0.01). warm group had significantly lower postoperative CK (532.78 ± 249.08 vs. 638.14 ± 344.01 IU/L; P< 0.01), CK-MB (78.64 ± 34.58 vs.  103.18 ± 82.11; P< 0.0.01), LDH level (805.3 ± 322.71 vs. 1060.88 ± 500.94 mg/dl; P< 0.01) and (0.4148 ± 0.226 vs. 0.6404 ± 0.411 ng/ml; P< 0.01).   Conclusion: Antegrade warm blood cardioplegia may provide better myocardial protection during valve surgery compared to the cold cardioplegia. A larger study is recommended.

How to Protect Hypertrophied Myocardium? A Prospective Clinical Trial of three Preservation Techniques

1997 ◽  
Vol 20 (8) ◽  
pp. 440-446 ◽  
Author(s):  
F Bouchart ◽  
J.P. Bessou ◽  
A. Tablet ◽  
B. Hecketsweiller ◽  
D. Mouton-Schleifer ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Heart Surgery ◽  
Ventilatory Support ◽  
Lactate Production ◽  
Blood Cardioplegia ◽  
Hypertrophied Myocardium ◽  
Significant Difference ◽  
Cold Blood ◽  
Warm Blood ◽  
Warm Blood Cardioplegia

Protection of the hypertrophied myocardium during heart surgery is still a controversial matter. We prospectively studied 3 currently available preservation techniques in 60 patients operated on for isolated aortic stenosis. Patients were randomly assigned to one of the following groups: CWB: continuous warm blood cardioplegia ICB: intermittent cold blood with warm blood controlled reperfusion Cryst: intermittent cold crystalloid cardioplegia (SLF11, Biosédra Laboratory, Vernon, France). All groups were matched for age, ejection fraction, NYHA class, aortic valve surface, and operative risk score. There were no deaths. No statistically significant difference was found among the groups in terms of ventilatory support time, ICU stay time, hospitalization or atrial fibrillation occurrence. Blood gases in the coronary sinus at the time of clamp release showed deep acidosis with crystalloid cardioplegia (pH = 7.11 vs 7.39 for CWB and 7.38 for UCB, p < 0.0001) associated with a higher lactate production than in the other groups (1.3 mmol vs 0.5 for CWB and 0.58 for ICB, p < 0.0001). Acidosis was corrected at the end of bypass with no significant differences among groups. CK-MB samples were taken on arrival in ICU, then 6 and 24 hours later. These samples showed much higher levels with cold blood (H6: 70 mcg/l vs 33 for CWB and 45 for Cryst, p = 0.0019). Although the 3 types of cardioplegia may be safely used for isolated aortic stenosis surgery, continuous warm blood cardioplegia appears to be the best choice.

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.

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.

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