Myocardial protection during CABG: Warm blood versus cold crystalloid cardioplegia, is there any difference?

Mourad, Faisal; Fadala, Mohsen A.; Ibrahim, Ahmed; Ammar, Ayman; Elnahas, Yasser; Elghanam, Mohamed A; Elkilany, Ibrahim S.

doi:10.1016/j.jescts.2016.09.001

Cited by 7 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, warm cardioplegia correlated with better postoperative cardiac indices and lower peak creatine kinase MB concentrations than cold cardioplegia [28]. The latter findings, along with reduced postoperative cardiac troponin levels, have been replicated in other studies [29,30]. Meanwhile, other studies comparing warm blood and cold crystalloid hyperkalemic cardioplegia do not show significant differences with respect to perioperative myocardial infarction and low cardiac output syndrome [31].…”

Section: Warm Vs Coldmentioning

confidence: 74%

Potassium and Cardiac Surgery

Kant¹,

Sellke²,

Feng³

2022

Physiology

View full text Add to dashboard Cite

Potassium homeostasis affects cardiac rhythm and contractility, along with vascular reactivity and vascular smooth muscle proliferation. This chapter will focus on potassium dynamics during and after cardiac surgery involving cardioplegic arrest and cardiopulmonary bypass (CPB). Hyperkalemic, hypothermic solutions are frequently used to induce cardioplegic arrest and protect the heart during cardiac surgery involving CPB. Common consequences of hyperkalemic cardioplegic arrest and reperfusion include microvascular dysfunction involving several organ systems and myocardial dysfunction. Immediately after CPB, blood potassium levels often drop precipitously due to a variety of factors, including CPB -induced electrolyte depletion and frequent, long-term administration of insulin during and after surgery. Meanwhile, some patients with pre-existing kidney dysfunction may experience postoperative hyperkalemia following cardioplegia. Any degree of postoperative hyper/hypokalemia significantly elevates the risk of cardiac arrythmias and subsequent myocardial failure. Therefore, proper management of blood potassium levels during and after cardioplegia/CPB is crucial for optimizing patient outcomes following cardiac surgery.

show abstract

Section: Warm Vs Coldmentioning

confidence: 74%

Potassium and Cardiac Surgery

Kant¹,

Sellke²,

Feng³

2022

Physiology

View full text Add to dashboard Cite

show abstract

“… 2/8 Martin et al E24 1994 CABG 493 CC: 508 ≥35 ≤8 Warm cardioplegia was associated with more neurologic events, as defined as stroke and encephalopathy, compared with cold cardioplegia. 4/8 Mourad et al E41 2016 CABG 50 CC: 50 NR NR Antegrade warm blood cardioplegia was associated with lower postoperative cardiac enzymes release. 9/9 Nardi et al E42 2018 CABG Valve 159 CC: 32 35-36 4 Cold crystalloid cardioplegia was associated with less postoperative cardiac enzymes release and comparable postoperative clinical outcomes compared with warm blood cardioplegia.…”

Section: Resultsmentioning

confidence: 99%

“… Study controls for most important confounding factor: 1 mark Study further controls for any additional potential confounding factor: 1 mark Assessment of outcome Independent or blind assessment stated in the paper, or confirmation of the outcome by reference to secure records/record linkage (ICD): 1 mark Self-report, no descriptions: 0 mark Based on your clinical judgement, was FU long enough for outcomes to occur? Yes: 1 mark No: 0 mark Adequacy of FU of cohorts Complete FU/subjects lost to FU unlikely to introduce bias: 1 mark No description: 0 mark Raza Baig et al 2015 E37 1 1 1 1 2 1 1 1 9 Candilio et al 2014 E38 1 1 1 1 2 1 1 1 9 De Jonge et al 2015 E39 0 1 1 1 2 1 1 1 8 Kuhn et al 2018 E40 0 1 1 1 2 1 1 1 8 Mourad et al 2016 E41 1 1 1 1 2 1 1 1 9 Nardi et...…”

Section: Appendixmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

“…The advantages of wBCP during adult cardiac surgery were demonstrated as early as 1989 [42]. Since that time, wBCP has been shown to be safe and effective based on several RCTs involving adult cardiac surgery and widely used in clinical practice [43][44][45]; however, wBCP needs to be proven to become the standard method in pediatric patients. Two retrospective studies [46,47] and two RCTs [8,16] focused on wBCP during pediatric cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery: A Network Meta-Analysis

Zhou¹,

Li²,

Zhang³

et al. 2021

Congenital Heart Disease

View full text Add to dashboard Cite

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery; however, which cardioplegia solution has the best protective effect has not been established. Thus, we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac surgery. Seven databases were searched to identify the relevant randomized controlled trials. A network meta-analysis with a Bayesian framework was conducted. The outcomes included the following biochemical and clinical outcomes: serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively; cardiac troponin I (cTnI) at 4, 12, and 24 h postoperatively; spontaneous beating after declamping; postoperative arrhythmias; inotropic support percentage and duration; mechanical ventilation hours; intensive care unit stay in days; hospital stay in days; and mortality. The group treated with cold crystalloid cardioplegia (cCCP) was chosen as the control group. The 22 studies involved 1529 patients. Six types of cardioplegia solutions were described in these studies, including cold blood cardioplegia, cCCP, del Nido, histidine-tryptophan-ketoglutarate (HTK), terminal warm blood cardioplegia, and warm blood cardioplegia (wBCP). The serum concentrations of the 24-h cTnI with wBCP (MD = −2.52, 95% CI: −4.74 to −0.27) was significantly lower than cCCP. The serum concentrations of the 24-h cTnI with HTK (MD = 4.91, 95% CI: 2.84-7.24) was significantly higher than cCCP. There was no significant difference in other biochemical and clinical outcomes when compared to cCCP. In conclusion, wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

show abstract

Myocardial protection during CABG: Warm blood versus cold crystalloid cardioplegia, is there any difference?

Cited by 7 publications

References 17 publications

Potassium and Cardiac Surgery

Potassium and Cardiac Surgery

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

Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery: A Network Meta-Analysis

Contact Info

Product

Resources

About