Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery

Ulugöl, Halim; Aksu, Uğur; Koçyiğit, Muharrem; Kilercik, Meltem; Karduz, Gülsüm; Ökten, Murat; Toraman, Fevzi

doi:10.5761/atcs.oa.18-00113

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Ulugol et al [20] in a small sample of CABG patients receiving warm blood or cold crystalloid cardioplegia focused their attention on the postoperative cellular injury, and they concluded that both cardioplegic solutions created similar effects on glycocalyx integrity, but myocardial protection was better achieved with the use of warm blood cardioplegia.…”

Section: Discussionmentioning

confidence: 99%

“…From a technical-surgical point of view, the use of crystalloid cardioplegia may offer some advantage by allowing a longer time available for the packaging of distal coronary artery anastomoses and an operating bloodless field at the site of the anastomosis. However, if the surgeons prefer the warm cardioplegia, they should pay more attention to the interval time of administration, a shorter time of repetition of the dose being required to achieve effective myocardial protection [1,18,20,[28][29][30]. In fact, several studies performed on the use of warm blood cardioplegia have suggested the importance of the re-dosing interval [28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

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Warm blood versus St. Thomas cardioplegia for myocardial protection in patients undergoing coronary artery bypass grafting

Nardi¹,

Pisano²,

Ferrante³

et al. 2019

kitp

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Aim: We retrospectively analyzed early results of coronary artery bypass grafting (CABG) surgery using antegrade intermittent warm blood or St. Thomas cold crystalloid cardioplegia. Material and methods: From January 2015 to May 2018, in 556 patients undergoing isolated CABG, cardiac arrest was obtained using warm blood (WB group, n = 402) or St. Thomas cardioplegia (ST group, n = 154). Myocardial enzymes' release was calculated at the end of CABG (time 0), 24, and 48 hours postoperatively. Results: In-hospital mortality was 1.74% in the WB group, 0.65% in the ST group. As compared with the WB group, in the ST group the number of distal coronary artery anastomoses per patient was significantly higher (2.9 ±0.9 vs. 2.6 ±0.8) (p = 0.003), despite a similar required number of cardioplegia doses per patient (2.2 ±0.9 vs. 2.3 ±0.9). The incidence of perioperative myocardial infarction, low cardiac output syndrome, myocardial enzymes release, rate of CK-MB/CK ratio > 10% was similar. As compared with the WB group, in the ST group the proportion of patients with CK-MB/CK ratio > 5% was lower at each time point of evaluation, with a significant difference at time 0 (30.5% vs. 48%) (p = 0.0005), whereas the need for blood transfusion per patient was higher (1.3 ±2.0 vs. 0.54 ±1.3) (p < 0.0001). Within the WB group, the rate of CK-MB/CK ratio > 5% was significantly reduced when dose administration was repeated within 18 minutes compared to 20-25 minutes (36% vs. 59%) (p < 0.0001). Duration of the extracorporeal circulation and of the aortic cross-clamping, and the mean number of coronary bypasses were not identified as risk factors either for the CK-MB/CK ratio greater than 10% or greater than 5%. Conclusions: Based on a single-center experience, both types of cardioplegia are associated with equivalent clinical results. St. Thomas cardioplegia, despite the greater number of grafts per patient and therefore greater extracorporeal circulation and aortic cross-clamping times, and greater postoperative need for blood transfusion, appears to be associated with

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Warm blood versus St. Thomas cardioplegia for myocardial protection in patients undergoing coronary artery bypass grafting

Nardi¹,

Pisano²,

Ferrante³

et al. 2019

kitp

View full text Add to dashboard Cite

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“…Besides these markers, near‐infrared spectroscopy (NIRS) gives noninvasive information on tissue perfusion. Sialic acid (SA) is a glycocalyx fragment which is shown through the effect of oxidative mediators, and its plasma levels increase after surgery 6 . Malondialdehyde (MDA) is one of the final products of polyunsaturated fatty acid peroxidation in the cells.…”

Section: Introductionmentioning

confidence: 99%

Effects of upper limb ischemia‐reperfusion on regional oxidative stress during aortic surgery with moderate hypothermia

Balcı

Demir²,

Özay

et al. 2021

J Card Surg

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Introduction This study aims to evaluate the effect of acute, iatrogenic right arm ischemia and reperfusion (I/R) due to right axillary cannulation on regional oxidative stress using tissue perfusion markers such as central venous oxygen saturation, lactate, the difference between central venous and arterial CO2 pressure, near‐infrared spectroscopy (NIRS) measurements, and biomarkers like sialic acid, malondialdehyde, advanced oxidative protein products in aortic surgery with moderate hypothermia. Methods Adult patients undergoing ascending aorta repair with antegrade cerebral perfusion via the axillary artery participated. Blood samples were collected from the internal jugular vein, right arm cubital vein, and left arm cubital vein, and analysis was performed at intraoperative time points. Results Right‐arm venous oxygen saturation levels are significantly lower than left arm and central venous, as expected in iatrogenic ischemia. Right arm lactate levels are significantly higher. Somatic right arm NIRS values are significantly lower than somatic left arm. There are no significant differences for biomarkers throughout the time points. Conclusions We have concluded that well‐known markers reflect the results of ischemia‐reperfusion more rapidly, and are more valuable than novel biomarkers. NIRS is a promising monitor in terms of providing information about tissue oxygenation. Oxidative stress biomarkers do not change quickly enough to give useful information in a short enough period of time; moreover, their costs are high and laboratory studies take time. Although axillary cannulation is controlled limb ischemia, the local effects of I/R did not completely normalize at the end of the surgery, and this regional I/R did not affect the global body organism.

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“…Hypervolemia and hemodilution causes increased plasma fHb levels, endothelial glycocalyx (EGL) damage, and activation of inflammatory processes. [ 3 4 5 ] There are in vitro and animal model data that find increased plasma free hemoglobin (fHb) related to inflammation, infection, platelet activation, vasculopathy and thrombosis. [ 6 ] In cardiac surgery, fHb is elevated due to both hemolysis caused by extracorporeal circuits,[ 4 ] and the inflammatory response induced by oxidative stress disrupting erythrocyte membrane integrity.…”

Section: Introductionmentioning

confidence: 99%

“…[ 6 ] In cardiac surgery, fHb is elevated due to both hemolysis caused by extracorporeal circuits,[ 4 ] and the inflammatory response induced by oxidative stress disrupting erythrocyte membrane integrity. [ 5 ] It has been shown in studies that fHb causes end organ damage and increases mortality, these data suggest that an increase in fHb may be a biomarker for poor clinical outcomes. [ 7 ]…”

Section: Introductionmentioning

confidence: 99%

Retrograde Autologous Priming Method Reduces Plasma Free Hemoglobin Level in Aortic Surgery

Balcı

Aykut

Demir

et al. 2021

Annals of Cardiac Anaesthesia

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Background: Although conventional cardiopulmonary bypass (cCPB) is still the most widely used method in open heart surgery, methods such as retrograde autologous priming (RAP) are increasingly popular in terms of limiting hemodilution. Our hypothesis is that the use of the RAP method in aortic surgery may result in a limitation of hemodilution and a decrease in fHb levels. For this purpose, plasma free hemoglobin (fHb) levels were investigated in adult open aortic arch repair with axillary artery cannulation patients using cCPB and rRAP methods. Materials and Methods: In this study, a total of 36 patients undergoing aortic surgery using rRAP and standard cCPB were investigated. Measurements were performed at five time points: After induction of anesthesia, 5th minute of CPB, 10th minute of antegrade cerebral perfusion, 30th minute after declamping of aorta, and at sternum closure. Besides hemodynamic variables, arterial blood gas analysis and postoperative variables, patients were assessed for fHb levels. Results: The rRAP group had a significantly lower increase in fHb levels in T3, T4, and T5 time points, when compared to the cCPB group (p = 0.002, 0.047, 0.009, respectively). There was no significant difference between the rRAP and cCPB groups in other intraoperative, and postoperative variables. Also, it was observed that rRAP did not make a difference in terms of blood and blood product transfusion. Conclusion: In this study, in patients undergoing aortic surgery, a reduction in the increase of fHb was observed with the rRAP method which is a simple procedure that does not require high cost or advanced technology.

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Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery

Abstract: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.

Cited by 12 publications

References 27 publications

Warm blood versus St. Thomas cardioplegia for myocardial protection in patients undergoing coronary artery bypass grafting

Warm blood versus St. Thomas cardioplegia for myocardial protection in patients undergoing coronary artery bypass grafting

Effects of upper limb ischemia‐reperfusion on regional oxidative stress during aortic surgery with moderate hypothermia

Retrograde Autologous Priming Method Reduces Plasma Free Hemoglobin Level in Aortic Surgery

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