Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

Abstract

Background: Because hearts in acute myocardial infarction are often prone to ischemia-reperfusion damage during cardiac surgery, we investigated the influence of intracellular crystalloid cardioplegia solution (CCP) and extracellular blood cardioplegia solution (BCP) on cardiac function, metabolism, and infarct size in a rat heart model of myocardial infarction. Methods: Following euthanasia, the hearts of 50 rats were quickly excised, cannulated, and inserted into a blood-perfused isolated heart apparatus. A regional myocardial infarction was created in the infarction group (18 hearts) for 120 min; the control group (32 hearts) was not subjected to infarction. In each group, either Buckberg BCP or Bretschneider CCP was administered for an aortic clamping time of 90 min. Functional parameters were recorded during reperfusion: coronary blood flow, left ventricular developed pressure (LVDP) and contractility (dp/dt max). Infarct size was determined by planimetry. The results were compared between the groups using analysis of variance or parametric tests, as appropriate. Results: Cardiac function after acute myocardial infarction, 90 min of cardioplegic arrest, and 90 min of reperfusion was better preserved with Buckberg BCP than with Bretschneider CCP relative to baseline (BL) values (LVDP 54 ± 11% vs. 9 ± 2.9% [p = 0.0062]; dp/dt max. 73 ± 11% vs. 23 ± 2.7% [p = 0.0001]), whereas coronary flow was similarly impaired (BCP 55 ± 15%, CCP 63 ± 17% [p = 0.99]). The infarct in BCP-treated hearts was smaller (25% of myocardium) and limited to the area of coronary artery ligation, whereas in CCP hearts the infarct was larger (48% of myocardium; p = 0.029) and myocardial necrosis was distributed unevenly to the left ventricular wall. Conclusions: In a rat model of acute myocardial infarction followed by cardioplegic arrest, application of BCP leads to better myocardial recovery than CCP.

Use of del Nido cardioplegia in acute coronary syndrome cases with decreased ejection fraction

“…In a recent experimental model of infarcted myocardium, blood cardioplegia provided better recovery than crystalloid cardioplegia. 20 We support the thesis that superiority of one solution over another may be observed in a particular clinical situation or particular cohort of patients.…”

Role of HTK cardioplegic solution in reducing inflammatory response during cardiac arrest: a rat model with a right thoracotomy

“…Cardiac surgery inevitably leads to ischemia/reperfusion (I/R) injury, potentially causing postoperative myocardial dysfunction, such as pulmonary dysfunction, atrial brillation, and renal failure(8). Currently, there are two primary categories of cardiac arrest solutions: one containing high levels of potassium, magnesium, and bicarbonate in the extracellular uid, and the other containing electrolyte components in the intracellular uid (4,9). The use of cardioplegia not only stops the heart but also reduces ischemia/reperfusion damage and improves immediate or long-lasting results (10)(11)(12)(13)(14).…”

“…Blood intrinsically possessed buffer capacity that might curtail myocardial swelling, alongside its function of oxygen transport, enabling rapid induction of arrest under oxygenated conditions. Conversely, the HTK solution-a sodium-de cient intracellular-type cardioplegic mediumelicited functionality through the reduction of extracellular sodium levels, and had garnered clinical recognition for e cacious organ preservation (4). Its broad adoption rested on its single-administration protocol, ensuring extended myocardial safeguarding exceeding two hours of cardiac asystole.…”

Comparison of Bretschneider HTK and Blood Cardioplegia (4:1): A Prospective Randomized Study

“…They concluded that perioperative CI and postoperative percent fractional shortening were significantly higher in the HTK group. On the other hand, in an experimental model of acute MI, Boening et al 26 noted that the application of Buckberg blood cardioplegia leads to better myocardial recovery than HTK after 90 minutes of cross-clamping. Gaudino et al 27 revealed that single dose HTK solution causes inferior RV protection compared with warm blood cardioplegia in patients with depressed preoperative RV function after mitral valve surgery.…”