Análise ultra-estrutural do miocárdio usando solução cardioplégica cristalóide com e sem procaína em pacientes submetidos à troca valvar aórtica

Abstract

Análise ultra-estrutural do miocárdio usando solução cardioplégica cristalóide com e sem procaína em pacientes submetidos à troca valvar aórtica Ultrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients undergoing aortic valve replacement Abstract Objective: The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level.Methods: Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A -eight patients receiving cardioplegia without procaine; group B -ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st -before ischemic arrest, 2nd -at the end of ischemic arrest, and 3rd -15 minutes after reperfusion.Results: The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 ± 0.2; 0.4 ± 0.3; 0.4 ± 0.4, and group B 0.2 ± 0.2; 0.4 ± 0.3; 0.7 ± 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024).Conclusion: Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added. 390DUSSIN, LH ET AL -Ultrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients undergoing aortic valve replacement Bras Cir Cardiovasc 2008; 23(3): 389-395 Rev

Cardioplegic strategies to protect the hypertrophic heart during cardiac surgery

“…The addition of procaine to crystalloid cardioplegia in patients undergoing aortic valve replacement surgery did not improve myocardial protection, but had better spontaneous return to sinus rhythm after reperfusion 74 . The addition of insulin to blood cardioplegia was found to improve myocardial protection in patients with left ventricular hypertrophy 75 .…”

Os leucócitos e a resposta inflamatória na lesão de isquemia-reperfusão

“…The promotion of neutropenia by leukocyte depletion filter (LDF) [11] and radiation [39], the association between NO and hypothermia during CPB reducing the adherence of leukocytes to the endothelium [40], the modifications of the cardioplegic solution [41], heparinization of the surface of the CPB system, the addition of anti-inflammatory and chelating agents of OFR to the circuit [4.42 to 44], were not sufficient to reduce inflammatory markers in the postoperative period and to support the standardization of with any of these alternatives to the procedure of CPB [45].…”

Circulação Extracorpórea

“…Plenty of other knowledge came along with this new technology relating to the physiology of circulation, the body's reactions to surgical aggressions and the domain knowledge in relation to the internal environment, in which all our cells are immersed and where metabolism is developed with the production of energy that makes us live [16][17][18][19][20][21][22][23][24][25][26][27]. These studies resulted in the understanding of homeostasis, a complex system of self-regulation responsible to maintain the multiple vital parameters within normal levels, during production of the energy previously cited.…”