Background: Blood cardioplegia is a technique with many variations in its use. Intermittent cross clamping with Lidoflazine has proven to deliver good cardioprotection in our center. Question: Is tepid (32°C) ant...Background: Blood cardioplegia is a technique with many variations in its use. Intermittent cross clamping with Lidoflazine has proven to deliver good cardioprotection in our center. Question: Is tepid (32°C) antegrade intermittent blood cardioplegia an efficient, safe and easy-to-use alternative to intermittent cross-clamping with Lidoflazine in elective isolated CABG in low-risk patients? Primary outcomes are heart enzymes (cTnI, CK-MB). Secondary outcomes are operation times, length of hospital stay, major complications and in-hospital mortality. Methods: From January 2012 until November 2012, 40 patients with LVEF ≥50%, EuroSCORE展开更多
While cardioplegia has been used on millions of patients during the last decades, the debate over the best technique is still going on. Cardioplegia is not only meant to provide a non-contracting heart and a field wit...While cardioplegia has been used on millions of patients during the last decades, the debate over the best technique is still going on. Cardioplegia is not only meant to provide a non-contracting heart and a field without blood, thus avoiding the risk of gas emboli, but also used for myocardial protection. Its electromechanical effect is easily confirmed through direct vision of the heart and continuous electrocardiogram monitoring, but there is no consensus on the best way to assess the quality of myocardial protection. The optimal approach is thus far from clear and the considerable amount of literature on the subject fails to provide a definite answer. Cardioplegia composition(crystalloid vs blood, with or without various substrate enhancement), temperature and site(s) of injection have been extensively researched. While less frequently studied, re-dosing interval is also an important factor. A common and intuitive idea is that shorter redosing intervals lead to improved myocardial protection. A vast majority of surgeons use re-dosing intervals of 20-30 min, or even less, during coronary artery bypass graft and multidose cardioplegia has been the "gold standard" for decades. However, one-shot cardioplegia is becoming more commonly used and is likely to be a valuable alternative. Some surgeons prefer the comfort of single-shot cardioplegia while others feel more confident with shorter re-dosing intervals. There is no guarantee that a single strategy can be safely applied to all patients, irrespective of their age, comorbidities or cardiopathy. The goal of this review is to discuss the rationale for short re-dosing intervals.展开更多
In the present experiment,fructose-1,6-diphosphate（FDP）and captopril（Cap）wereadded to the cold potassium cardioplegia solution and the levels of malondialdehyde（MDA）,cre-atine phosphokinase MB（CPK-MB）,thrombox...In the present experiment,fructose-1,6-diphosphate（FDP）and captopril（Cap）wereadded to the cold potassium cardioplegia solution and the levels of malondialdehyde（MDA）,cre-atine phosphokinase MB（CPK-MB）,thromboxane B（TXB<sub>2</sub>）and 6-keto-PGF<sub>1α</sub> in plasma weremeasured during open-heart surgery.Quantitative study of myocardial ultrastructure and obser-vation of cardiac resuscitation were also undertaken.The findings suggested that FDP,especiallywhen combined with Cap could significantly strengthen the protective effects of cold potassiumcardioplegia solution on ischemic myocardium.展开更多
Whether the ATP sensitive potassium channel opener pinacidil can provide myocardial protective effects in prolonged isolated global ischemic rat heart was investigated. On modified isolated rat working heart model, 4...Whether the ATP sensitive potassium channel opener pinacidil can provide myocardial protective effects in prolonged isolated global ischemic rat heart was investigated. On modified isolated rat working heart model, 40 hearts were divided into four groups randomly: Hyperpolarized arrest H K solution containing pinacidil (50 μmol/L) (P1 and P2) and depolarized arrest St. Thomas' solution (S1 and S2) subjected to 15 ℃ hypothermia, 60 min (P1 and S1) or 120 min (P1 and S2) of ischemia and 30 min reperfusion. The experimental indices included cardioplegic efficiency, cardiac function, coronary blood flow, myocardial enzyme release, myocardial water and ATP content. Hyperpolarized arrest provided significantly better recovery of cardiac function than depolarized arrest. Postischemic coronary flow and myocardial ATP content were higher. The arrest time of electro mechanical activities were longer than depolarized arrest. There were no differences among the groups in myocardial water contents. The hyperpolarized arrest solution containing pinacidil can provide a marked myocardial protective effect during prolonged hypothermic myocardial ischemia.展开更多
To evaluate the effect of amino acid cardioplegia on myocardial metabolism and function of ischemic canine heart, canine cardiopulmonary bypass (CPB) model was established and the dog heart was subjected to a 120 min ...To evaluate the effect of amino acid cardioplegia on myocardial metabolism and function of ischemic canine heart, canine cardiopulmonary bypass (CPB) model was established and the dog heart was subjected to a 120 min ischemic arrest. Animals were divided into 3 groups, group 1:warm blood cardioplegia induction and terminal perfusion plus 4 C ST. Thomas hospital solution (STS)during ischemia;group 2: warm blood cardioplegia enriched with amino acid (L-asparte and L-glutamate 13 mmol/L each) and STS without amino acid (A.G.) and group 3:both warm blood cardioplegic solution and STS enriched with A. G..The result demonstrated that the cardiac function of animals in group 2 and 3 had a significantly better recovery after ischemic-re-perfusion. By the end of ischemia the content of myocardial ATP in group 3 was distinctly higher than that in group 1(P<0. 05), with the release of cardiac enzyme being the least. Myocardial ultra-structure almost remained intact before and after ischemia. Our experiment suggests that the cardioplegia arrest with warm blood and cold crystalloid solution enriched with amino acids could diminish the ischemia-re-perfusion injuries of the heart and enhance the effect of myocardial protection.展开更多
Myocardial protection during open heart surgery was studied in 52 patients with complex congenital heart disease. Twenty-six patients received b1ood cardioplegia (BCP) and 26 crystalloid cardioplegia (CCP). Release of...Myocardial protection during open heart surgery was studied in 52 patients with complex congenital heart disease. Twenty-six patients received b1ood cardioplegia (BCP) and 26 crystalloid cardioplegia (CCP). Release of serum enzymes (creatine kinase, CK; hybrid muscle-brain CK isoenzyme, CK-MB; aspartate aminotransferase, ASTF and 1actic dehydrogenase, LDH) was determined pre-and post-operatively. DUring the first 72 h post-operation, release of CK, CK-MB, AST and LDH in the 2 groups was different, In case of tetralogy of Fallot (TOF) the CK-MB released in l3CP and CCP 12 h after operation were 51. 29±9. 42 and 85. 77±22. 39 U/L respectively (P<0. 05). In the CCP group of TOF, CK-MB level increased significantly even at 72 h after operation (30. 91±14. 32 U/L vs the pre-operative value of 14. 57±7. 51 U/L). The results show a better myocardial preservation in the BCP group as compared with the CCP group. BCP can maintain metabolic homeostasis of the myocardium, reduce myocardial injury and increase the content of myocardial high energy phosphate during ischemia. Tolerance to ischemia is poor in patients with complex congenital heart disease. Therefore, preservation of high energy phosphates is necessary for severe-grade patients and BCP is superior to crysta1loid cardioplegia in this regard. It is concluded that CCP results in a higher release of CK-MB as compared with BCP group. BCP is superior to CCP for myocardial protection in patients with complex congenital heart disease.展开更多
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 myocardia...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.展开更多
文摘Background: Blood cardioplegia is a technique with many variations in its use. Intermittent cross clamping with Lidoflazine has proven to deliver good cardioprotection in our center. Question: Is tepid (32°C) antegrade intermittent blood cardioplegia an efficient, safe and easy-to-use alternative to intermittent cross-clamping with Lidoflazine in elective isolated CABG in low-risk patients? Primary outcomes are heart enzymes (cTnI, CK-MB). Secondary outcomes are operation times, length of hospital stay, major complications and in-hospital mortality. Methods: From January 2012 until November 2012, 40 patients with LVEF ≥50%, EuroSCORE
文摘While cardioplegia has been used on millions of patients during the last decades, the debate over the best technique is still going on. Cardioplegia is not only meant to provide a non-contracting heart and a field without blood, thus avoiding the risk of gas emboli, but also used for myocardial protection. Its electromechanical effect is easily confirmed through direct vision of the heart and continuous electrocardiogram monitoring, but there is no consensus on the best way to assess the quality of myocardial protection. The optimal approach is thus far from clear and the considerable amount of literature on the subject fails to provide a definite answer. Cardioplegia composition(crystalloid vs blood, with or without various substrate enhancement), temperature and site(s) of injection have been extensively researched. While less frequently studied, re-dosing interval is also an important factor. A common and intuitive idea is that shorter redosing intervals lead to improved myocardial protection. A vast majority of surgeons use re-dosing intervals of 20-30 min, or even less, during coronary artery bypass graft and multidose cardioplegia has been the "gold standard" for decades. However, one-shot cardioplegia is becoming more commonly used and is likely to be a valuable alternative. Some surgeons prefer the comfort of single-shot cardioplegia while others feel more confident with shorter re-dosing intervals. There is no guarantee that a single strategy can be safely applied to all patients, irrespective of their age, comorbidities or cardiopathy. The goal of this review is to discuss the rationale for short re-dosing intervals.
基金The project was supported by the National Natural Science Foundation of China No.3880772
文摘In the present experiment,fructose-1,6-diphosphate（FDP）and captopril（Cap）wereadded to the cold potassium cardioplegia solution and the levels of malondialdehyde（MDA）,cre-atine phosphokinase MB（CPK-MB）,thromboxane B（TXB<sub>2</sub>）and 6-keto-PGF<sub>1α</sub> in plasma weremeasured during open-heart surgery.Quantitative study of myocardial ultrastructure and obser-vation of cardiac resuscitation were also undertaken.The findings suggested that FDP,especiallywhen combined with Cap could significantly strengthen the protective effects of cold potassiumcardioplegia solution on ischemic myocardium.
基金This project was supported by a grant from EducationalMinistry Foundation of China (No.[2 0 0 1]34 5 )
文摘Whether the ATP sensitive potassium channel opener pinacidil can provide myocardial protective effects in prolonged isolated global ischemic rat heart was investigated. On modified isolated rat working heart model, 40 hearts were divided into four groups randomly: Hyperpolarized arrest H K solution containing pinacidil (50 μmol/L) (P1 and P2) and depolarized arrest St. Thomas' solution (S1 and S2) subjected to 15 ℃ hypothermia, 60 min (P1 and S1) or 120 min (P1 and S2) of ischemia and 30 min reperfusion. The experimental indices included cardioplegic efficiency, cardiac function, coronary blood flow, myocardial enzyme release, myocardial water and ATP content. Hyperpolarized arrest provided significantly better recovery of cardiac function than depolarized arrest. Postischemic coronary flow and myocardial ATP content were higher. The arrest time of electro mechanical activities were longer than depolarized arrest. There were no differences among the groups in myocardial water contents. The hyperpolarized arrest solution containing pinacidil can provide a marked myocardial protective effect during prolonged hypothermic myocardial ischemia.
文摘To evaluate the effect of amino acid cardioplegia on myocardial metabolism and function of ischemic canine heart, canine cardiopulmonary bypass (CPB) model was established and the dog heart was subjected to a 120 min ischemic arrest. Animals were divided into 3 groups, group 1:warm blood cardioplegia induction and terminal perfusion plus 4 C ST. Thomas hospital solution (STS)during ischemia;group 2: warm blood cardioplegia enriched with amino acid (L-asparte and L-glutamate 13 mmol/L each) and STS without amino acid (A.G.) and group 3:both warm blood cardioplegic solution and STS enriched with A. G..The result demonstrated that the cardiac function of animals in group 2 and 3 had a significantly better recovery after ischemic-re-perfusion. By the end of ischemia the content of myocardial ATP in group 3 was distinctly higher than that in group 1(P<0. 05), with the release of cardiac enzyme being the least. Myocardial ultra-structure almost remained intact before and after ischemia. Our experiment suggests that the cardioplegia arrest with warm blood and cold crystalloid solution enriched with amino acids could diminish the ischemia-re-perfusion injuries of the heart and enhance the effect of myocardial protection.
文摘Myocardial protection during open heart surgery was studied in 52 patients with complex congenital heart disease. Twenty-six patients received b1ood cardioplegia (BCP) and 26 crystalloid cardioplegia (CCP). Release of serum enzymes (creatine kinase, CK; hybrid muscle-brain CK isoenzyme, CK-MB; aspartate aminotransferase, ASTF and 1actic dehydrogenase, LDH) was determined pre-and post-operatively. DUring the first 72 h post-operation, release of CK, CK-MB, AST and LDH in the 2 groups was different, In case of tetralogy of Fallot (TOF) the CK-MB released in l3CP and CCP 12 h after operation were 51. 29±9. 42 and 85. 77±22. 39 U/L respectively (P<0. 05). In the CCP group of TOF, CK-MB level increased significantly even at 72 h after operation (30. 91±14. 32 U/L vs the pre-operative value of 14. 57±7. 51 U/L). The results show a better myocardial preservation in the BCP group as compared with the CCP group. BCP can maintain metabolic homeostasis of the myocardium, reduce myocardial injury and increase the content of myocardial high energy phosphate during ischemia. Tolerance to ischemia is poor in patients with complex congenital heart disease. Therefore, preservation of high energy phosphates is necessary for severe-grade patients and BCP is superior to crysta1loid cardioplegia in this regard. It is concluded that CCP results in a higher release of CK-MB as compared with BCP group. BCP is superior to CCP for myocardial protection in patients with complex congenital heart disease.
文摘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.
