Is repeated administration of blood-cardioplegia really necessary?

Ghazy, Tamer; Allham, Omar; Ouda, Ahmed; Kappert, Utz; Matschke, Klaus

doi:10.1510/icvts.2008.192757

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…Minatoya et al [ 15 ] reported that intermittent warm BC provided 30 minutes of safe ischemia in patients who underwent coronary bypass surgery. Ghazy et al [ 16 ] showed that the protection of the first shot of warm cardioplegia might be > 20 minutes. Later, the same group reported that the time interval between the warm cardioplegic doses could be safely increased to > 35 minutes [ 17 ] .…”

Section: Discussionmentioning

confidence: 99%

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

Sevük¹,

Dursun²,

Ar³

2022

Braz J Cardiovasc Surg

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Introduction Del Nido cardioplegia was reported to provide adequate myocardial protection and clinical outcomes with improved surgical flow in adult cardiac surgical procedures. And many clinicians have already modified the traditional formula. This study aims to investigate the efficacy and safety of tepid modified del Nido cardioplegia compared to cold blood cardioplegia in adult patients undergoing cardiac surgery. Methods This retrospective study included one hundred consecutive adult patients undergoing cardiac surgical procedures using tepid modified del Nido cardioplegia. One hundred consecutive adult patients undergoing cardiac surgical procedures with cold blood cardioplegia were the control group. Propensity score matching yielded 89 modified del Nido and 89 cold blood cardioplegia patients. Results There were no significant differences when comparing the two matched groups regarding the requirement for intraoperative defibrillation ( P =0.36), postoperative peak troponin T levels (0.18), perioperative inotropic support ( P =0.26), intra-aortic balloon pump requirement ( P =0.62), and postoperative left ventricular ejection fraction at discharge ( P =0.4) and on the sixth postoperative month ( P =0.37). Mean cross-clamping time ( P =0.005), cardiopulmonary bypass time ( P =0.03), and total operation time ( P =0.03) were significantly shorter in the del Nido group. Conclusion Tepid modified del Nido cardioplegia may be a safe alternative to cold blood cardioplegia in adult patients undergoing cardiac surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

Sevük¹,

Dursun²,

Ar³

2022

Braz J Cardiovasc Surg

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“…(2018) demonstrated that the safe interval for infusion of normothermic blood cardioplegia was 13 minutes. 15 Ghazy T. et al (2009) indicated that "the standard in the literature is still the repeated infusion of cardioplegic blood solution every 15 minutes". 16 Molina GR et al (2018) noted that once cross-clamp is applied, and infusion of cold blood cardioplegia has begun, typical ECG changes can be observed in one to two minutes time and an isoelectric ECG recording is obtained after 3 to 4 minutes that lasts for at least 90 minutes or longer.…”

Section: Discussionmentioning

confidence: 99%

The retrospective observational study of clinical outcomes of single dose infusion of warm blood cardioplegia in patients undergoing cardiac surgery

Чернов

Ivashchenko

Mandel

2021

Preprint

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Objective: The aim of the study was to assess the safety and efficacy of a normothermic cardioplegia solution N trademark use and obtain additional information about dosing regimens during normothermic or mild hypothermic cardiac surgery. Methods: A retrospective observational study included 150 cardio surgery patients. The primary endpoint was the intraoperative acute heart failure development. The secondary endpoints were the postoperative Troponin T concentrations, the need for catecholamine support, and the repeated infusion of a cardioplegia solution. Results: The duration of aortic cross-clamping varied from 17 to 154 minutes, median 59 [interquartile range, 46 - 73] minutes. Spontaneous sinus rhythm recovery was observed in 136 (90.7%) patients. Intraoperative acute heart failure was observed in 1 case. The Troponin T concentrations were 0.331 plus-or-minus sign 0.143 ng/mL after surgery. Mortality was 2% (3 patients). Eight patients received an additional volume of N trademark solution to maintain asystole. Among 16 patients with a cross-clamp duration greater than 90 minutes epinephrine was used in 3 (18.8%) patients in doses of more than 0.05 mcg/kg/min. Among 134 patients cross-clamp duration less than 90 minutes the catecholamine support was used in 4 (3%) patients, p=0.027. Conclusions: A primary single-dose infusion of cardioplegia solution N trademark provides myocardial protection for 59 (interquartile range, 46-73) minutes and up to 154 minutes. The catecholamine support in the group of aortic cross-clamp duration less than 90 minutes was used lesser than in the group of aortic cross-clamp duration greater than 90 minutes (3% and 18.8%, respectively). The cardioprotection during cardiopulmonary bypass surgery especially in elderly patients with concomitant disease needs to be confirmed in future investigations.

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“…It was 5 min in 1992 ( 79 ), 10–15 min in 1995 ( 73 – 75 ), 30 min in 2000 ( 80 ), or even more. Single shot warm blood cardioplegia was used for aortic clamp time between 29 and 47 min ( 81 ).…”

Section: Warm Cardiac Surgery the Adult Experiencementioning

confidence: 99%

Rationale for Implementation of Warm Cardiac Surgery in Pediatrics

Durandy

2016

Front. Pediatr.

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Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia–reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery.

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Is repeated administration of blood-cardioplegia really necessary?

Cited by 12 publications

References 9 publications

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A PropensityMatched Analysis

The retrospective observational study of clinical outcomes of single dose infusion of warm blood cardioplegia in patients undergoing cardiac surgery

Rationale for Implementation of Warm Cardiac Surgery in Pediatrics

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