Clinical validation of St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol)

Abstract

Recently, the St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol) has become available commercially in the UK. In a series of patients (n = 28) undergoing open heart surgery for a variety of lesions, a clinical validation was performed. Preservation of myocardial contractility was assessed biophysically by quantitative birefringence measurements of myocardial biopsy samples (full thickness apical left ventricle and right ventricle) taken (1) prior to ischaemia, (2) at the end of ischaemia and (3) 10-15 min after reperfusion during cardiopulmonary bypass. In addition, serum CK-MB values were measured in samples taken throughout the operation and for 4 days postoperatively. Postoperative ECG traces (taken every 6 h for 48 h and then daily up to 7 days) were analysed to identify the occurrence of perioperative infarction. There were no hospital deaths. Chronotropic support was required in 5 of 28 patients (18%) for transient heart block. Low cardiac output did not occur postoperatively. Birefringence measurements in biopsy samples taken at the end of the ischaemic period (immediately prior to reperfusion) indicated an apparent left ventricular deterioration in myocardial contractility in 12 of 28 patients (43%) when compared to biopsies sampled prior to the ischaemic period. However, after 10-15 min of aerobic reperfusion, measurements indicated that myocardial contractility recovered to almost pre-ischaemic levels in the majority of patients. Thus, in 22 of 28 patients (79%), left ventricular deterioration did not occur in post-ischaemic biopsy samples when compared to the pre-ischaemic biopsies. Similarly, 21 of 28 patients (75%) had no deterioration of birefringence values in right ventricular biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary Graft Failure after Heart Transplantation

“…Cardioplegic/storage solutions such as St Thomas' Solution No. 2 (Plegisol), Bretschneider (Custodiol), and Celsior, have been in widespread clinical use since the early 1990's [58–60] and appear to provide adequate protection of “standard criteria” of donor hearts subjected to ischaemic times of less than 4 hours [1]. The cardioprotective capacities of such formulations may be suboptimal for the increasing numbers of “marginal” donor hearts seen in current clinical practice, particularly those subjected to prolonged ischaemic times.…”

Improved Myocardial Function After Cold Storage With Preservation Solution Supplemented With a Carbon Monoxide–Releasing Molecule (CORM-3)

“…After cervical dislocation and exsanguination, hearts were perfused on a Langendorff circuit as described previously. 29,30 Measurements were recorded for left ventricular developed pressure (LVDP), its first derivatives (dP/dt max and dP/dt min ), and enddiastolic pressure (EDP) and coronary flow rates. 30 All hearts were based at 300 beats per minute.…”

Custodiol HTK versus Plegisol: in-vitro comparison with the use of immature (H9C2) and mature (HCM) cardiomyocytes cultures

“…Plegisol (Hospira Inc, USA) based on STH N°2 (St. Thomas’ Hospital, London) extracellular solution (high K + ) as a multi-dose solution is used from the ‘70 s of the last century [ 6 ]. Plegisol requires buffering with the NaHCO 3 just before administration.…”