Comparison of del Nido Cardioplegia with Blood Cardioplegia in Coronary Artery Bypass Grafting Combined with Mitral Valve Replacement.

OBJECTIVE: To compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement. METHODS: A 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects. RESULTS: Both groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005). CONCLUSION: DNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.

Comparison of del nido cardioplegia with blood cardioplegia in coronary artery bypass grafting combined with mitral valve replacement

Abstract Objective: To compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement. Methods: A 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects. Results: Both groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005). Conclusion: DNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.

A avaliação da proteção miocárdica utilizando solução cardioplégica sanguínea versus solução cardioplégica cristalóide: estudo em modelo experimental de coração isolado / The evaluation of myocardial protection using blood cardioplegic solution versus crystalloid cardioplegic solution: study in an isolated heart model

Resumo: INTRODUÇÃO: O efeito deletério provocado pela isquemia e reperfusão do miocárdio durante a parada cardíaca apresenta-se como uma das principais causas da síndrome de baixo débito cardíaco no período pós-operatório. Neste sentido, a utilização de solução cardioplégica na indução da parada cardíaca eletiva tem sido o método mais utilizado e difundido de proteção do miocárdio. No entanto, a padronização do método ou tipo ideal de solução cardioplégica ainda é controverso devido à escassez de estudos com o delineamento claro das vantagens e desvantagens na comparação entre as soluções utilizadas nos serviços de cirurgia. OBJETIVOS: A avaliação da recuperação contrátil dos corações com a administração em dose única das soluções cardioplégicas del Nido (sanguínea) versus Custodiol (cristalóide), após serem mantidos por longo período em isquemia global. E a avaliação de proteínas relacionadas com a dinâmica do cálcio intracelular, a atividade de proteases envolvidas com a morte celular programada assim como a preservação energética miocárdica. MÉTODOS: Corações de ratos Wistar macho foram perfundidos de forma isolada de acordo com a técnica de Langendorff clássico. A administração das soluções cardioplégicas em dose única (30 ml/Kg) induziram os corações ao período 3 horas de isquemia fria, seguido pelo período de 90 minutos de reperfusão. Os corações foram divididos em dois grupos; (I) del Nido (n = 6) versus (II) Custodiol (n = 6). A avaliação da recuperação contrátil do ventrículo esquerdo foi realizada durante a reperfusão pelas variáveis hemodinâmicas: PSVE, PDVE, dP/dt máxima, dP/dt mínima, PPDFC e RC. Ao fim da reperfusão as amostras de tecido do ventrículo esquerdo foram coletadas para as análises de proteínas envolvidas com a dinâmica do cálcio intracelular (fosfolambam e SERCA2a) de acordo com a técnica de immunoblot, atividade das caspases 3/7 e a concentração de ATP miocárdico de acordo com a técnica de bioluminescência. RESULTADOS: A solução cardioplégica sanguínea del Nido atribuiu aos corações a recuperação da função contráctil superior em comparação com a solução cristalóide Custodiol. As análises das variáveis hemodinâmicas mostraram resultados superiores com a solução sanguínea, conforme apresentam-se respectivamente: PSVE (90 minutos), 28 ± 7% vs. 50 ± 2%; PDVE (90 minutos), 32 ± 6 vs. del 56 ± 2%; dP/dt máxima (30 minutos), 28 ± 12% vs. 66 ± 10%; dP/dt mínima (30 minutos), 24 ± 10% vs. 53 ± 9%; PPDFC (30 minutos), 18 ± 9% vs. 53 ± 11%. A concentração de ATP miocárdico (P <0,05) e a ativação da fosfolambam (P <0,05) também apresentaram resultados superiores nos corações que receberam a solução cardioplégica del Nido. CONCLUSÕES: A solução cardioplégica sanguínea del Nido demonstrou maior capacidade de proteção do miocárdio em comparação com solução cardioplégica Custodiol de acordo com a maior preservação da recuperação contrátil do ventrículo esquerdo. A elevada concentração de ATP no miocárdio e a maior ativação da fosfolambam são dados que atestam o desempenho ventricular superior com a solução cardioplégica del Nido, demonstrando a maior capacidade de proteção do miocárdio por esta solução(AU)

Abstract: INTRODUCTION: The deleterious effect caused by myocardial ischemia and reperfusion during cardiac arrest is one of the main causes of low cardiac output syndrome in the postoperative period. In this sense, the use of cardioplegic solution on induction of elective cardiac arrest has been the most widely used and widespread method of myocardial protection. However, the standardization of the ideal method or type of cardioplegic solution is still controversial due to the scarcity of studies with a clear delineation about the advantages and disadvantages comparing solutions used in the surgery services. OBJECTIVES: The contractile recovery evaluation from hearts induced to long-term of global ischemia with the single dose of cardioplegic solutions administration by del Nido (blood-based) versus Custodiol (crystalloid). In addition, the evaluation of intracellular calcium dynamics proteins, the activity of proteases involved with programmed cell death as well as myocardial energy preservation. METHODS: Male Wistar hearts rats were submitted to isolated perfusion according to the classic Langendorff technique. The single dose of cardioplegic solutions (30 ml/kg), induced the hearts to the period 3-hours of cold ischemia, followed by the 90-minute of reperfusion. The hearts were divided into two groups; (I) del Nido (n = 6) versus (II) Custodiol (n = 6). The evaluation of left ventricular contractile recovery was performed throughout the reperfusion according to hemodynamic variables: LVSP, LVDP, maximum dP/dt, minimum dP/dt, RPP and CR. Subsequently, at the end of reperfusion the left ventricular tissue samples were collected for analysis of proteins involved with intracellular calcium dynamics (phospholamban and SERCA2a) according to the immunoblot technique and the activity of the caspases 3/7 and myocardial ATP concentration according to the bioluminescence technique. RESULTS: Del Nido blood-based cardioplegic solution provided to the hearts higher contractile recovery comparing to the Custodiol crystalloid cardioplegic solution. The hemodynamic variables analysis showed superior results with the blood-based solution as presented respectively: LVSP (90 minutes), 28 ± 7% vs. 50 ± 2%; LVDP (90 minutes), 32 ± 6 vs. 56 ± 2%; dP/dt maximum (30 minutes), 28 ± 12% vs. 66 ± 10%; dP/dt minimum (30 minutes), 24 ± 10% vs. 53 ± 9%; RPP (30 minutes), 18 ± 9% vs. 53 ± 11%. Ultimately, both analysis with myocardial ATP concentration (P <0.05) and the activation of phospholamban (P <0.05) presented higher levels in the hearts which received the del Nido cardioplegic solution(AU)

Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients.

OBJECTIVE:: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS:: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS:: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION:: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

Single-dose lignocaine-based blood cardioplegia in single valve replacement patients

Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

Improvement in cardioplegic perfusion technique in single aortic clamping - initial results.

INTRODUCTION: The most common method used for myocardial protection is administering cardioplegic solution in the coronary circulation. Nevertheless, protection may be achieved by intermittent perfusion of the coronary system with patient's own blood. The intermittent perfusion may be performed by multiple sequences of clamping and opening of the aortic clamp or due single clamping and accessory cannulation of the aortic root as in the improved technique proposed in this study, reperfusion without the need for multiple clamping of the aorta. OBJECTIVE: To evaluate the clinical outcome and the occurrence of neurological events in in-hospital patients submitted to myocardial revascularization surgery with the "improved technique" of intermittent perfusion of the aortic root with single clamping. METHODS: This is a prospective, cross-sectional, observational study that describes a myocardial management technique that consists of intermittent perfusion of the aortic root with single clamping in which 50 patients (mean age 58.5 ± 7.19 years old) have been submitted to the myocardial revasculrization surgery under the proposed technique. Clinical and laboratory variables, pre- and post-surgery, have been assessed. RESULTS: The mean peak level of post-surgery CKMB was 51.64 ± 27.10 U/L in the second post-surgery and of troponin I was 3.35 ± 4.39 ng/ml in the fourth post-surgery, within normal limits. No deaths have occurred and one patient presented mild neurological disorder. Hemodynamic monitoring has not indicated any changes. CONCLUSION: The myocardial revascularization surgery by perfusion with the improved technique with intermittent aortic root with single clamping proved to be safe, enabling satisfactory clinical results.

Aperfeiçoamento em técnica de perfusão cardioplégica no pinçamento único de aorta - resultados iniciais / Improvement in cardioplegic perfusion technique in single aortic clamping - initial results

INTRODUÇÃO: O método mais comumente utilizado para a proteção miocárdica é o de administrar-se solução cardioplégica na circulação coronária. Entretanto, a proteção pode ser alcançada através da perfusão intermitente do sistema coronariano com sangue do próprio paciente, que é realizada por meio de múltiplas sequências de pinçamento e abertura do clamp aórtico ou por meio do pinçamento único e canulação acessória da raiz aórtica. Objetivo: Avaliar o desfecho clínico e a ocorrência de eventos neurológicos no período intra-hospitalar dos pacientes submetidos à cirurgia de revascularização do miocárdio com a técnica proposta aqui neste estudo. Métodos: Descreve-se uma técnica de proteção miocárdica no uso do pinçamento único de aorta que consiste na canulação acessória da raiz aórtica com sistema aperfeiçoado para perfusão coronária intermitente, foi realizado estudo observacional transversal prospectivo onde foram estudados 50 pacientes (idade média 58,5±7.19 anos) submetidos à cirurgia de revascularização do miocárdio sob a técnica proposta. Foram avaliadas variáveis clínicas e laboratoriais pré e pós-operatórias. Resultados: O nível médio de pico da CKMB pós-operatória foi de 51,64±27,10 U/L no segundo pós-operatório e da troponina I foi de 3,35±4,39 ng/ml no quarto pós-operatório, e estiveram dentro do limite da normalidade. Não foi observado nenhum óbito e um paciente evoluiu com alteração neurológica leve. A monitorização hemodinâmica não revelou alterações. Conclusão: A cirurgia de rev...

Introduction: The most common method used for myocardial protection is administering cardioplegic solution in the coronary circulation. Nevertheless, protection may be achieved by intermittent perfusion of the coronary system with patient's own blood. The intermittent perfusion may be performed by multiple sequences of clamping and opening of the aortic clamp or due single clamping and accessory cannulation of the aortic root as in the improved technique proposed in this study, reperfusion without the need for multiple clamping of the aorta. Objective: To evaluate the clinical outcome and the occurrence of neurological events in in-hospital patients submitted to myocardial revascularization surgery with the "improved technique" of intermittent perfusion of the aortic root with single clamping. Methods: This is a prospective, cross-sectional, observational study that describes a myocardial management technique that consists of intermittent perfusion of the aortic root with single clamping in which 50 patients (mean age 58.5±7.19 years old) have been submitted to the myocardial revasculrization surgery under the proposed technique. Clinical and laboratory variables, pre- and post-surgery, have been assessed. Results: The mean peak level of post-surgery CKMB was 51.64±27.10 U/L in the second post-surgery and of troponin I was 3.35±4.39 ng/ml in the fourth post-surgery, within normal limits. No deaths have occurred and one patient presented mild neurological disorder. Hemodynamic monitoring has not indicated any changes. Conclusion: The myocardial revascularization surgery by perfusion with the improved technique with intermittent aortic root with single clamping proved to be safe, enabling satisfactory clinical results. .

Deleterious effect of hypothermia in myocardial protection against cold ischemia: a comparative study in isolated rat hearts.

BACKGROUND: There is a growing need to improve heart preservation benefit the performance of cardiac operations, decrease morbidity, and more important, increase the donor pool. Therefore, the objective of this study was to evaluate the cardioprotective effects of Krebs-Henseleit buffer (KHB), Bretschneider-HTK (HTK), St. Thomas No. 1 (STH-1), and Celsior (CEL) solutions infused at 10°C and 20°C. METHODS: Hearts isolated from male albino Wistar rats and prepared according to Langendorff were randomly divided equally into 8 groups according to the temperature of infusion (10°C or 20°C) and cardioprotective solutions (KHB, HTK, STH-1, and CEL). After stabilization with KHB at 37°C, baseline values were collected (control) for heart rate (HR), left ventricle systolic pressure (LVSP), coronary flow (CF), maximum rate of rise of left ventricular pressure during ventricular contraction (+dP/dt) and maximum rate of fall of left ventricular pressure during left ventricular relaxation (-dP/dt). The hearts were then perfused with cardioprotective solutions for 5 minutes and kept for 2 hours in static ischemia at 20°C. Data evaluation used analysis of variance (ANOVA) in all together randomized 2-way ANOVA and Tukey's test for multiple comparisons. The level of significance chosen was P < .05. RESULTS: We observed that all 4 solutions were able to recover HR, independent of temperature. Interestingly, STH-1 solution at 20°C showed HR above baseline throughout the experiment. An evaluation of the corresponding hemodynamic values (LVSP, +dP/dt, and -dP/dt) indicated that treatment with CEL solution was superior at both temperatures compared with the other solutions, and had better performance at 20°C. When analyzing performance on CF maintenance, we observed that it was temperature dependent. However, when applying both HTK and CEL, at 10°C and 20°C respectively, indicated better protection against development of tissue edema. Multiple comparisons between treatments and hemodynamic variable outcomes showed that using CEL solution resulted in significant improvement compared with the other solutions at both temperatures. CONCLUSION: The solutions investigated were not able to fully suppress the deleterious effects of ischemia and reperfusion of the heart. However, these results allow us to conclude that temperature and the cardioprotective solution are interdependent as far as myocardial protection. Although CEL solution is the best for in myocardial protection, more studies are needed to understand the interaction between temperature and perfusion solution used. This will lead to development of better and more efficient cardioprotective methods.

Inclusion of lidocaine in cardioplegic solutions provides additional myocardial protection.

AIM: Lidocaine inhibits depolarization by blocking sodium and calcium influx and potassium release, abolishing the action potentials of cells in the Hiss-Purkinje system and myocit cells. As it can directly influence cardiac electric and mechanical activities, this study evaluated the efficacy of lidocaine in providing myocardial protection during normothermic blood cardioplegia. METHODS: Twenty-six dogs were randomly assigned to groups based on the cardioplegic induction solution they were to receive. Group I dogs (n=10) received a solution consisting of lidocaine (5 mg/kg), KCL (41.6 mEq/L) and 180 ml of normothermic blood. Group II dogs (n=10) received the same solution, except for the lidocaine and group III dogs (n=6) received only normothermic blood. In addition, 120 ml of normothermic blood was reinfused every 20 min. All dogs underwent cardiopulmonary bypass, 2 hours of global myocardial ischemia and 3 hours of reperfusion. Statistical differences were determined with the chi squared test, the two-way analysis of variance and Bonferroni's test. RESULTS: There were no deaths in group I. The survival rate in group II was 60%, and no dogs in group III survived (p=0.025). No difference in lactate liberation or left ventricular function (i.e., cardiac outflow and ejection fraction) was observed between groups. However, animals in group I demonstrated less enzymatic releases (troponin I, p=0.049 and CK, p=0.026) and less mitochondrial ultrastructural changes (p=0.022). CONCLUSIONS: Lidocaine offers myocardium additional protection against ischemia during cardiopulmonary bypass.

Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty.

OBJECTIVE: To evaluate the effects of glucose-insulin-potassium (GIK) therapy on infarct size and left ventricular function when used as an adjuvant therapy to primary angioplasty. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Cardiac intensive care unit at a university hospital. PATIENTS: Thirty-seven patients with acute myocardial infarction for whom primary angioplasty was indicated. INTERVENTIONS: Eligible patients were randomized by a blinded pharmacist to GIK solution (30% glucose in water with insulin 50 U/L, and KCl 40 mM/L) vs. placebo at 1.5 mL/kg/hr for 24 hrs. MEASUREMENTS AND MAIN RESULTS: Tc 99m sestamibi myocardial scintigraphy was performed at admission and at 3 months. Primary end points were the changes in left ventricular ejection fraction (LVEF) and the size of salvaged myocardium. Baseline clinical characteristics were similar in both groups. At the 3-month follow-up, a significant overall decrease in infarct size (37 +/- 16% vs. 12 +/- 10%, p <.005) and an increase in LVEF (34 +/- 13% vs. 49 +/- 9%, p =.005) were observed. Patients randomized to GIK solution experienced a significant increase in their LVEF at 3 months (39 +/- 12 to 51 +/- 13, p =.002). Patients who received placebo had no significant differences between baseline and 3-month measurements (44 +/- 13 vs. 49 +/- 14, p = NS). There was a trend toward an increase in myocardial salvage in the GIK group, which did not reach statistical significance. When patients from both groups were compared directly, differences in LVEF improvement were no longer significant. CONCLUSIONS: GIK solution did not improve LVEF or decrease the infarct size among patients undergoing primary angioplasty.

Study of the parietal coronary sinus valve under scanning electron microscopy

La cardioplejia retrógrada es un procedimiento usado regularmente para proteger el miocardio durante las cirugías del corazón. Consiste en hacer perfusión retrógrada, a través del seno coronario, la principal vena cardíaca. Este método ha mostrado ser muy útil, pues el sistema venoso del corazón no presenta procesos obstructivos ateroscleróticos. La desembocadura del seno coronario ocurre directamente en el atrio derecho, donde una valva ostial es referida a este nivel. Pero la presencia de una valva parietal en el seno coronario ha renovado el interés de estudio. Esta valva podría dificultar la perfecta perfusión de la solución cardioplégica, particularmente cuando se usan presiones bajas. Para entender mejor la morfología y por tanto la función de la valva parietal del seno coronario, realizamos un estudio de esta valva en microscopio electrónico de barrido (MEB). Utilizamos 6 muestras de 1cm², conteniendo el seno coronario a nivel de la valva parietal, las que fueron retiradas de individuos adultos post mortem, sin patologías macroscópicas. Las muestras fueron sometidas a las técnicas habituales de MEB. La valva parietal mostró un aspecto en media luna bien definido. Su endotelio presentó estructuras paralelas, semejantes a troncos de árboles, en los cuales se pudieron evidenciar los núcleos de las células endoteliales. Por debajo de la capa endotelial encontramos abundantes fibras colágenas y elásticas. Debido al gran desarrollo de la valva del seno coronario observada al MEB, ésta debe tener un papel importante en la orientación del contenido sanguíneo por el seno coronario, en dirección al atrio derecho, en condiciones fisiológicas y podrá crear dificulatades al flujo de la solución durante el procedimiento de la cardioplegia retrógrada

Cardioplejia retrógrada por canulación transauricular derecha del seno coronario / Retrograde cardioplegia trrough right transatrial cannulation of the coronary sinus

LA infusión de solución cardiopléjica por vía anterógrada tiene una demostrada efectividad protectora del miocardio durante la cirugía cardiaca. Sin embargo, en presencia de enfermedad coronaria grave, reoperaciones e hipertrofia ventricular esta efectividad puede ser limitada. Por otra parte, en cirugía valvular, interfiere con el desarrollo expedito dela operación. En estas circunstancias, la infusión retrógrada de solución cardiopléjica permite una mejor distribución de ésta en el miocardio. En 42 pacientes (32 hombres) operados entre septiembre de 1991 y septiembre de 1992 se utilizó para la protección del miocardio la infusión retrógrada solución cardiopléjica cristaloide, exclusiva o adicionada a la infusión anterógrada, a través de la canulación transauricular derecha del seno coronario, con un catéter especialmente diseñado. Veintidós casos correspondieron a revascularizaciones miocárdicas, y 20, a procedimientos valvulares. Nueve pacientes (21 por ciento ) tenían una disfunción ventricular severa, 8 estaban cursando un infarto miocárdico, y 7 casos fueron reoperaciones. No hubo ningún caso de infarto perioperatorio electrocardiográfico, pero 2 pacientes (4,8 por ciento ) presentaron elevación de CPK-MB significativa para injuria miocárdica. Once pacientes (26 por ciento ) requirieron inótropos en el postoperatorio (dopamina y/o dobutamina en 9 casos). Ninguno requirió balón de contrapulsación. No hubo morbilidad relacionada con la canulación del seno coronario ni con la infusión retrógrada de solución cardiopléjica. No hubo mortalidad hospitalaria. En esta experiencia inicial, la canulación transauricular derecha del seno coronario permite la infusión retrógrada de solución cardiopléjica en forma simple y efectiva, ofreciendo una buena protección miocárdica

[Surgical treatment of primary tumors of the heart]. / Khirurgicheskoe lechenie pervichnykh opukholei serdtsa.

The article discusses the experience in surgical treatment of tumors of the heart in 34 patients in clinics of cardiosurgery at the Riga Medical Institute and the Institute of Cardiology and Cardiovascular Surgery of Havana (Cuba). Twenty-five patients underwent operations for benign tumors of the heart (16 myxomas, 2 leiomyomas, 2 fibromas, 1 lipoma, 1 angiofibroma, 2 coelomic cysts) under extracorporeal circulation, with 4% lethality. No recurrences were encountered in follow-up periods of 5 months to 14 years. Nine patients had malignant tumors; the tumor was removed successfully in 3 of them, even with resection and prosthetic replacement of the outflow tract of the right ventricle. Only 3 of the patients (33%) who were operated on had a follow-up period of more than 1 year.

Transplantes cardiopulmonar e pulmonar com soador em localidade distante / Distant donor procurement for heart-lung and lung transplantation

Em situaçöes específicas, os transplantes clínicos cardiopulmonares e pulmonar säo, hoje, formas estabelecidas de tratamento para estágio final de doença cardiopulmonar e pulmonar. A obtençäo de doadores adequados permanece o maior problema e a remoçäo de órgäos em localidades distantes é, hoje, uma necessidade. Embora muitos métodos de preservaçäo pulmonar possam ser empregados, para períodos isquêmicos de até 5 horas, a hipotermia e o uso de soluçäo cardioplégica com infusäo da soluçäo de Collins modificada no tronco pulmonar tem sido método simples e eficiente para preservaçäo do bloco coraçäo-pulmäo. Descrevemos, aqui, o método corrente que empregamos, com o qul os transplantes cardiopulmonar e pulmonar combinados foram sucedidos de excelente funçäo cárdio-respiratória

A cardioplegia oxigenada na proteçäo miocárdica durante a cirurgia cardíaca: estudo clínico e enzimático / Oxygenated cardioplegia in myocardial protection during cardiac surgery: a clinical and enzymatic study

A cardioplegia tem sido reconhecida como um fator muito importante na proteçäo do miocárdio. Sabe-se que, mesmo a 15-C, o coraçäo consome oxigênio. Testes in vitro demonstraron que a cardioplegia cristalóide libera mais oxigênio que a sangüínea. Neste trabalho, foram analisadas as variaçöes hemodinâmicas, eletrocardiográficas e enzimáticas em 26 pacientes divididos em 2 grupos, nos quais a cardioplegia cristalóide de Gomes foi empregada. A avaliaçäo dos pacientes incluiu a recuperaçäo hemodinâmica após a parada cardíaca, o uso de drogas vasoativas, o ritmo e o aspecto do eletrocardiograma (ECG), a freqüência cardíaca (FC), a pressäo arterial média (PAM), a pressäo venosa central (PVC) e as enzimas TGO e CPK-MB. Estes parâmetros foram medidos nos seguintes tempos: antes, logo após a cirurgia e após 6, 12, 24, 48, 72 horas de pós-operatório. Os resultados demonstraram que a recuperaçäo hemodinâmica foi similar em ambos os grupos. O uso de drogas vasoativas foi maior no Grupo II. No ECG, observou-se mais bradicardia e fibrilaçäo ventricular no Grupo II do que no Grupo I. A frqüência cardíaca, a pressäo arterial média e a pressäo venosa central näo mostraram diferenca significativa em ambos os grupos. As enzimas TGD e CPK-MB mostraram elevaçäo mais acentuada no Grupo I do que no II e essa diferença foi significativa (P < 0,01). Em conclusäo, os dados sugerem que houve comportamento semelhante em ambas as soluçöes, quanto à recuperaçäo hemodinâmica e a parâmetros vitais. Observou-se uma incidência maior de bradicardia no Grupo II, provavelmente relacionada à maior duraçäo da parada cardíaca, com maior número de infusöes de soluçäo cardioplégica. A variaçäo das enzimas sugere que a soluçäo com maior número de infusöes de soluçäo cardioplégica. A variaçäo das enzimas sugere que a soluçäo oxigenada foi mais efetiva do que a näo oxigenada, para a preservaçäo do miocárdio

Protection of the immature myocardium. An experimental evaluation of topical cooling, single-dose, and multiple-dose administration of St. Thomas' Hospital cardioplegic solution.

Low cardiac output in infants after cardiac operations continues to be a problem, yet little experimental work has been done to evaluate the various methods of protecting the immature myocardium. In this study, we have used an isolated working heart model to test three methods of myocardial protection in 3- to 4-week-old rabbit hearts: (1) topical cooling, (2) single-dose cardioplegia plus topical cooling, and (3) multiple-dose cardioplegia plus topical cooling. Myocardial temperature was maintained at 10 degrees C during ischemia, and St. Thomas' Hospital solution was used for cardioplegia. Sets of 18 hearts were subjected to 60, 90, or 120 minutes of ischemia, and within each set six hearts were protected by all three methods. After 90 and 120 minutes of ischemia, the percent recovery of aortic flow (expressed as mean +/- standard error of the mean) was lower in hearts protected with multiple-dose cardioplegia plus topical cooling (61.5% +/- 4.8%, 50.7% +/- 14.2%) than in those protected with topical cooling (92.4% +/- 5.7%, 94.3% +/- 12.8%) or single-dose cardioplegia plus topical cooling (86.4% +/- 5.3%, 90.2 +/- 3.6%). However, adenosine triphosphate, creatine phosphate, and glycogen levels were adequately preserved in all groups. Both topical cooling and single-dose cardioplegia provide effective protection for the immature rabbit heart during ischemia, but multiple-dose cardioplegia plus topical cooling results in inadequate preservation of hemodynamic function, despite adequate preservation of myocardial high-energy phosphate stores.