Continuous Warm Blood Cardioplegia for Congenital Heart Surgery.

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.

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Intermittent warm blood cardioplegia in the surgical treatment of congenital heart disease: Clinical experience with 1400 cases

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2006.10.004 ◽

2007 ◽

Vol 133 (1) ◽

pp. 241-246 ◽

Cited By ~ 32

Author(s):

Yves Durandy ◽

Sylvie Hulin

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Surgical Treatment ◽

Clinical Experience ◽

Congenital Heart ◽

Blood Cardioplegia ◽

Warm Blood ◽

Warm Blood Cardioplegia

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Intermittent antegrade warm-blood versus cold-blood cardioplegia in children undergoing open heart surgery: a protocol for a randomised controlled study (Thermic-3)

BMJ Open ◽

10.1136/bmjopen-2020-036974 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036974

Author(s):

Rachael Heys ◽

Serban Stoica ◽

Gianni Angelini ◽

Richard Beringer ◽

Rebecca Evans ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Postoperative Blood Loss ◽

Cardioplegic Arrest ◽

Blood Cardioplegia ◽

Paediatric Patients ◽

Cold Blood ◽

Warm Blood ◽

Randomised Controlled ◽

Cold Blood Cardioplegia

IntroductionSurgical repair of congenital heart defects often requires the use of cardiopulmonary bypass (CPB) and cardioplegic arrest. Cardioplegia is used during cardiac surgery requiring CPB to keep the heart still and to reduce myocardial damage as a result of ischaemia–reperfusion injury. Cold cardioplegia is the prevalent method of myocardial protection in paediatric patients; however, warm cardioplegia is used as part of usual care throughout the UK in adults. We aim to provide evidence to support the use of warm versus cold blood cardioplegia on clinical and biochemical outcomes during and after paediatric congenital heart surgery.Methods and analysisWe are conducting a single-centre randomised controlled trial in paediatric patients undergoing operations requiring CPB and cardioplegic arrest at the Bristol Royal Hospital for Children. We will randomise participants in a 1:1 ratio to receive either ‘cold-blood cardioplegia’ or ‘warm-blood cardioplegia’. The primary outcome will be the difference between groups with respect to Troponin T levels over the first 48 postoperative hours. Secondary outcomes will include measures of cardiac function; renal function; cerebral function; arrythmias during and postoperative hours; postoperative blood loss in the first 12 hours; vasoactive-inotrope score in the first 48 hours; intubation time; chest and wound infections; time from return from theatre until fit for discharge; length of postoperative hospital stay; all-cause mortality to 3 months postoperative; myocardial injury at the molecular and cellular level.Ethics and disseminationThis trial has been approved by the London – Central Research Ethics Committee. Findings will be disseminated to the academic community through peer-reviewed publications and presentation at national and international meetings. Patients will be informed of the results through patient organisations and newsletters to participants.Trial registration numberISRCTN13467772; Pre-results.

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Intermittent Antegrade Warm Blood Cardioplegia: What Is Next?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1679925 ◽

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.

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

The Heart Surgery Forum ◽

10.1532/hsf.4103 ◽

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.

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

The International Journal of Artificial Organs ◽

10.1177/039139889702000806 ◽

1997 ◽

Vol 20 (8) ◽

pp. 440-446 ◽

Cited By ~ 6

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.

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