Does the use of a hot-shot lead to improved outcomes following adult cardiac surgery?

Volpi, Sara; Ali, Jason M.; Silva, Ravi De

doi:10.1093/icvts/ivy266

Cited by 8 publications

(4 citation statements)

References 8 publications

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“…In prolonged ischemia and in high-risk patients, myocardial recovery may be delayed, due to increased inotrope support and preload in the early period after bypass. With terminal warm blood cardioplegia, these negative effects can be eliminated in the energy depleted myocardium [Volpi 2019]. In addition, although the superiority of del Nido cardioplegia in preventing intracellular acidosis is known, there is always a potential risk of Na and Ca overload.…”

Section: Discussionmentioning

confidence: 99%

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

Karaarslan

Abud

2021

HSF

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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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Section: Discussionmentioning

confidence: 99%

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

Karaarslan

Abud

2021

HSF

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“…Gambardella and colleagues 14 performed a meta-analysis in 2019 comparing single versus multidose cardioplegia, suggesting that more studies were needed to compare effects of different solution types, as current evidence were not yet conclusive. In addition, terminal hot-shot cardioplegia was proposed as a potential way to improve clinical outcomes, yet a systematic review performed by Volpi and colleagues 15 in 2019 concluded that there was insufficient evidence to evaluate its clinical merits. Mallidi and colleagues 16 conducted an observational study, suggesting that warm blood cardioplegia was associated with better long-term survival and less late MI than cold blood cardioplegia.…”

Section: Discussionmentioning

confidence: 99%

Warm versus cold cardioplegia in cardiac surgery: A meta-analysis with trial sequential analysis

et al. 2021

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Objective: This meta-analysis aimed to compare clinical outcomes of warm and cold cardioplegia in cardiac surgeries in adult patients, with trial sequential analysis (TSA) used to determine the conclusiveness of the results.Methods: Electronic searches were performed on PubMed, Medline, Scopus, EM-BASE, and Cochrane library to identify all studies that compared warm and cold cardioplegia in cardiac surgeries. Primary end points were in-hospital or 30-day mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, and new atrial fibrillation. Secondary end points were acute kidney injury, hospital length of stay, and intensive care unit length of stay. Prespecified subgroup analyses were performed for (1) studies published since publication of Fan and colleagues in 2010, (2) randomized controlled studies, (3) studies with low risk of bias, (4) coronary artery bypass graft surgeries, and (5) studies with cold blood versus those with cold crystalloid cardioplegia. TSA was performed to determine conclusiveness of the results, using on all outcomes without significant heterogeneity from studies of low risk of bias.Results: No significant differences were found between post-operative rates of mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, new atrial fibrillation, and acute kidney injury between warm and cold cardioplegia. TSA concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes.Conclusions: Concerning safety outcomes, current evidence suggests that the choice between warm and cold cardioplegia remains in the surgeon's preference.

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“…The resulting myocardial injury is associated with postoperative morbidity and, in the long term, can lead to heart failure. Therefore, the search continues for an optimal cardioprotective cardioplegic solution (3)(4)(5)(6)(7). Understandably, most of the studies that have been conducted to assess cardioprotective interventions were done during coronary artery bypass graft (CABG) surgery and were uncritically extended to other pathologies (8,9).…”

Section: Pathology-related Changes In Cardiac Energy Metabolites Infl...mentioning

confidence: 99%

Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery

Skeffington

Moscarelli²,

Abdul‐Ghani³

et al. 2022

Front. Cardiovasc. Med.

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IntroductionChanges in cardiac metabolites in adult patients undergoing open-heart surgery using ischemic cardioplegic arrest have largely been reported for non-ventricular tissue or diseased left ventricular tissue, with few studies attempting to assess such changes in both ventricular chambers. It is also unknown whether such changes are altered in different pathologies or linked to the degree of reperfusion injury and inflammatory response. The aim of the present work was to address these issues by monitoring myocardial metabolites in both ventricles and to establish whether these changes are linked to reperfusion injury and inflammatory/stress response in patients undergoing surgery using cold blood cardioplegia for either coronary artery bypass graft (CABG, n = 25) or aortic valve replacement (AVR, n = 16).MethodsVentricular biopsies from both left (LV) and right (RV) ventricles were collected before ischemic cardioplegic arrest and 20 min after reperfusion. The biopsies were processed for measuring selected metabolites (adenine nucleotides, purines, and amino acids) using HPLC. Blood markers of cardiac injury (Troponin I, cTnI), inflammation (IL- 6, IL-8, Il-10, and TNFα, measured using Multiplex) and oxidative stress (Myeloperoxidase, MPO) were measured pre- and up to 72 hours post-operatively.ResultsThe CABG group had a significantly shorter ischemic cardioplegic arrest time (38.6 ± 2.3 min) compared to AVR group (63.0 ± 4.9 min, p = 2 x 10−6). Cardiac injury (cTnI release) was similar for both CABG and AVR groups. The inflammatory markers IL-6 and Il-8 were significantly higher in CABG patients compared to AVR patients. Metabolic markers of cardiac ischemic stress were relatively and significantly more altered in the LV of CABG patients. Comparing diabetic and non-diabetic CABG patients shows that only the RV of diabetic patients sustained major ischemic stress during reperfusion and that diabetic patients had a significantly higher inflammatory response.DiscussionCABG patients sustain relatively more ischemic stress, systemic inflammatory response and similar injury and oxidative stress compared to AVR patients despite having significantly shorter cross-clamp time. The higher inflammatory response in CABG patients appears to be at least partly driven by a higher incidence of diabetes amongst CABG patients. In addition to pathology, the use of cold blood cardioplegic arrest may underlie these differences.

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Does the use of a hot-shot lead to improved outcomes following adult cardiac surgery?

Cited by 8 publications

References 8 publications

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

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

Warm versus cold cardioplegia in cardiac surgery: A meta-analysis with trial sequential analysis

Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery

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