Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model

Münch, Frank; Purbojo, Ariawan; Kellermann, S.; Janssen, Carina; Cesnjevar, Robert; Rüffer, André

doi:10.1093/ejcts/ezu440

Cited by 10 publications

(12 citation statements)

References 26 publications

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“…Recovery of cardiac function after cardiac arrest was better after BCP, and the infarct size was smaller. Our results support the previous findings of Münch et al who observed superior contractility after ischemia with BCP in a piglet model [18], Feng et al who reported less apoptosis, preserved left ventricular function, and lower coronary resistance after BCP in a rabbit model [11], and Runge et al who found more rapid normalization of myocardial metabolism in a porcine model [12]; all of these experiments were conducted without myocardial infarction. Julia et al [13], Vinten-Johansen [14], and Catinella et al [15] showed superiority of BCP over CCP, with better recovery of contractile function after BCP in dog heart infarction models.…”

Section: Discussionsupporting

confidence: 92%

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

Boening

Hinke

Heep

et al. 2020

J Cardiothorac Surg

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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.

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Section: Discussionsupporting

confidence: 92%

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

Boening

Hinke

Heep

et al. 2020

J Cardiothorac Surg

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“…This is consistent with most of the existing literature. 5,7,8,13 In our study, significant CKMB release was defined as a value above 80 µg/L. Braathen et al 9 found higher CKMB levels in patients receiving CC vs BC, but the levels reported were lower than our cut-off point (CC: 56.1 vs BC: 29.3 µg/L).…”

Section: Discussionmentioning

confidence: 74%

“…When the data was pooled, no significant difference was seen in the results of Sá et al whereas Guru et al found a significant reduction in low cardiac output syndrome in favour of BC. Others also report improved cardiac status when BC is used: Münch et al 13 describe better preload independent contractility (this was an animal study on piglets) and Luciani et al 14 a lower incidence of acute right heart failure (but no difference in predischarge ventricular kinetics) in transplanted patients who received BC. In general, inotropes are used in our department when the clinician suspects impaired cardiac function.…”

Section: Discussionmentioning

confidence: 99%

Blood cardioplegia benefits only patients with a long cross-clamp time

et al. 2018

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“…Better postoperative myocardial contractility was reported after blood cardioplegia administration [ 24 , 25 ]. Due to the incompleteness of echocardiographic data this parameter was not included in the study.…”

Section: Discussionmentioning

confidence: 99%

Type of cardioplegic solution as a factor influencing the clinical outcome of open-heart congenital procedures

Sobieraj

Kilanowska

Ładziński

et al. 2018

kitp

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IntroductionCardioplegia is one of the most important modalities of myocardial protection during heart surgery.AimTo assess the impact of blood cardioplegia on postoperative variables, in comparison with two types of crystalloid cardioplegic solutions during pediatric heart surgery.Material and methodsOne thousand one hundred and twenty-nine patients underwent surgical correction of congenital heart disease with cardioplegia administration between 2006 and 2012. Nonlinear regression models of postoperative low cardiac output syndrome (LCOS) incidence, catecholamine index and total complication count were developed using a genetic algorithm. The Akaike information criterion was applied for selection of the best model. The following explanatory variables were evaluated: cardioplegia type (ST – Saint Thomas, n = 440; FR – Fresenius, n = 432; BL – Calafiore, n = 257), congenital heart diseases (CHD) type, age, sex, genetic disorder presence, body surface area (BSA), cardiopulmonary bypass (CBP) time, aortic cross-clamp time, operation urgency, redo surgery, surgeon.ResultsLow cardiac output syndrome presence and higher than average catecholamine indexes were negatively influenced by use of crystalloid cardioplegia (ST or FR), presence of specific CHDs, redo surgery and prolonged CBP time. Increased complication count was related to: crystalloid cardioplegia, presence of specific CHDs, redo surgery, urgency of operation, operation time and CBP time. Higher BSA had a protective effect against higher catecholamine index and increased complication count. Older age was protective against LCOS.ConclusionsCardioplegic solutions type influences postoperative variables in children after heart surgery by the negative impact of crystalloid cardioplegia. Blood cardioplegia presents potential advantages for patients – its application may reduce the incidence of low cardiac output syndrome and related complications.

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Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model

Cited by 10 publications

References 26 publications

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

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

Blood cardioplegia benefits only patients with a long cross-clamp time

Type of cardioplegic solution as a factor influencing the clinical outcome of open-heart congenital procedures

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