Fundamentals of the Past: Cardioplegia: The First Period Revisited

Gunnes, Sigurd; Jynge, Per

doi:10.1007/978-3-211-85548-5_2

Cited by 12 publications

(15 citation statements)

References 81 publications

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“…The cardioplegic solution protects the myocardium against ischemia and events during reperfusion. [ 1 ] The use of hypothermic and hyperkalemic cardioplegia solutions have evolved to become the clinical standard. [ 1 ] The main factors explored were composition (blood versus crystalloid), various substrate enhancement, the route (antegrade, retrograde, or both), the temperature (cold, tepid, or warm), and the redosing intervals.…”

Section: Discussionmentioning

confidence: 99%

“…The main principles of myocardial protection are reduction of metabolic activity by hypothermia and diastolic arrest of the electrical activity of the heart by administering cardioplegia. [ 1 ] This provides the surgical team with a still, bloodless field essential for their surgical precision.…”

Section: Introductionmentioning

confidence: 99%

“…The two main types that have gained widespread acceptance are diastolic arrest induced and maintained with potassium added to either blood-based solution or a crystalloid-based solution. [ 1 3 ] There are several types of blood cardioplegia that differ in their electrolyte and drug additives which are supplemented to stabilize the membrane potential. Some examples are Buckberg solution, Plegisol solution, and St. Thomas solution.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia

et al. 2020

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Objectives: del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC). Materials and Methods: This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC. Results: There was no difference in cardiopulmonary bypass time ( P = 0.516) and clamp time ( P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable ( P = 0.344) ( P = 0.40). The incidence of clamp release ventricular fibrillation ( P = 0.207) was similar. The creatine kinase-MB isotype levels for the CABG patients were comparable on all 3 days ( P = 0.104), ( P = 0.106), and ( P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation ( P = 0.186), ICU days ( P = 0.931), and postoperative complications ( P = 0.354) were comparable. There was no 30-day mortality or postoperative myocardial infarction in both the groups. Conclusion: DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia

et al. 2020

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“…1 Cardioplegic solutions should improve tolerance to ischemia and reperfusion by preserving myocardial energy reserves, preventing osmotic and electrolyte imbalances and offer buffering for acid-base disturbances. 2 Some other important factors that needs to be considered for myocardial protection are the myocardial reserve and contractile state of the myocardial tissue, the temperature of the tissue, and the composition of the coronary blood at the onset of ischemia by aortic cross clamp (CC) during cardiopulmonary bypass (CPB). 3 St. Thomas' Hospital solution no 1 (STH1) was introduced clinically by Braimbridge in 1975.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Comparative Study of Del Nido Versus Intermittent St Thomas Hospital Blood Cardioplegia Solutions in Aortic-Mitral Double Valve Replacement

Dasbaksi¹,

Hossain²,

Haldar³

et al. 2020

IJCMR

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Introduction: It is not uncommon in patients, having rheumatic mitral and aortic valve disease, to undergo mitral valve replacement with aortic valve replacement that is, double valve replacement (DVR) operation who often have severe cardiac dysfunction optimized with medical management before surgery. In this retrospective study we investigated 60 such patients, who underwent DVR operation with either conventional cold blood cardioplegia with St Thomas 2 solution (STH), or del Nido cardioplegia (DN) over five years and compared the effects of the two types of cardioplegia during perioperative and postoperative period with simultaneous comparative study between changes of cardiac performances in the patients with larger left ventricle as compared to those with less enlarged ones. Material and methods: For this retrospective study, the data of 60 patients of DVR over five years, in Medical College, Kolkata, India, were retrieved for study. The cases were placed into 2 groups: STH and DN according to cardioplegia used during DVR. Demographic, echocardiographic, and several perioperative and postoperative data of the two groups of patients, were collected. Differences between perioperative behaviour between STH and DN groups and post operative changes in the echocardiographic parameters between predominantly mitral stenosis (MS) and mitral regurgitation (MR) patients, were analyzed. Results: The aortic cross clamp (CC) and cardiopulmonary bypass (CPB) time in both predominant MS and MR patients was shorter in the DN than the STH groups. There was less arrhythmia, less inotropic and ventilator support in the DN group. There was 10% mortality in the series with majority being in the STH and MR predominant patients. Postoperative improvement of LVEF, reduction of LVIDS and LVIDD were also observed in MS predominant in comparison to MR predominant patients after DVR in both STH and DN groups. Conclusion: Use of DN has been found to have a better outcome and survival when compared to STH cardioplegia solution. DVR could reversely remodel depressed hearts with relatively smaller LV volume and restore LV function of relatively smaller LV of predominant MS patients better in comparison to MR predominant patients with relatively dilated hearts.

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“…When cardioplegia was introduced in clinical heart surgery, it was combined with hypothermia to bring the myocardial temperature down to less than 10 C [1,2]. The myocardial temperature was measured with a needle temperature-probe placed centrally in the septum.…”

Section: Introductionmentioning

confidence: 99%

How to avoid severe coronary vasoconstriction in potassium induced cardioplegia

Qin

Chen

Sjöberg

et al. 2018

Scandinavian Cardiovascular Journal

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Objectives. The aim of this study was to investigate how high K þ concentrations can be safely used in cardioplegic solutions without causing severe coronary artery vasocontraction. Design. Twenty-four 50 kg pigs were used. The distal part of the left anterior descending coronary artery was cut into ring segments and transferred into organ baths with Krebs solution bubbled with 95% O 2 and 5% CO 2. K þ concentrations between 16 and 127 mM were used to induce vasocontractions at 37, 22, 15, and 8 C. Mg 2þ (0-20 mM) were used to attenuate K þ induced vasocontractions. Results. K þ-Krebs solution 127 mM at 37 C induced a strong, sustained vasocontraction defined as 100%.

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Fundamentals of the Past: Cardioplegia: The First Period Revisited

Cited by 12 publications

References 81 publications

Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia

Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia

A Retrospective Comparative Study of Del Nido Versus Intermittent St Thomas Hospital Blood Cardioplegia Solutions in Aortic-Mitral Double Valve Replacement

How to avoid severe coronary vasoconstriction in potassium induced cardioplegia

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