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1.
J Trauma Acute Care Surg ; 87(1): 68-75, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30985476

RESUMO

BACKGROUND: Adenosine, lidocaine, and magnesium (ALM) is a cardioplegic agent shown to improve survival by improving cardiac function, tissue perfusion, and coagulopathy in animal models of shock. We hypothesized prehospital ALM treatment in hemorrhagic shock would improve survival compared to current Tactical Combat Casualty Care (TCCC) resuscitation beyond the golden hour. METHODS: Swine were randomized to: (1) TCCC, (2) 2 mL·kg vehicle control (VC), (3) 2 mL·kg ALM + drip, (4) 4 mL·kg ALM + drip, 5) 4 mL·kg ALM + delayed drip at 0.5 mL·kg·h, 6) 4 mL/kg VC, 7) 4 mL·kg ALM for 15 minutes + delayed drip at 3 mL·kg·h. Animals underwent pressure controlled hemorrhage to mean arterial pressure (MAP) of 30 mm Hg (S = 0). Treatment was administered at T = 0. After 120 minutes of simulated prehospital care (T = 120) blood product resuscitation commenced. Physiologic variables were recorded and laboratories were drawn at specified time points. RESULTS: Tactical Combat Casualty Care demonstrated superior survival to all other agents. The VC and ALM groups had lower MAPs and systolic blood pressures compared with TCCC. Except for the VC groups, lactate levels remained similar with correction of base deficit after prehospital resuscitation in all groups. Kidney function and liver function remained comparable across all groups. Compared with baseline values, TCCC demonstrated significant hypocoagulability. CONCLUSION: Adenosine, lidocaine, and magnesium, as administered in this study, are inferior to current Hextend-based resuscitation for survival from prolonged hemorrhagic shock in this model. In survivors, ALM groups had lower systolic blood pressures and MAPs, but provided a protective effect on coagulopathy as compared to TCCC. Adenosine, lidocaine, and magnesium do not appear to be a suitable low volume replacement to current TCCC resuscitation. The reduced coagulopathy compared to TCCC warrants future studies of ALM, perhaps as a therapeutic adjunct.


Assuntos
Adenosina/uso terapêutico , Soluções Cardioplégicas/uso terapêutico , Serviços Médicos de Emergência/métodos , Lidocaína/uso terapêutico , Magnésio/uso terapêutico , Medicina Militar/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Adenosina/administração & dosagem , Animais , Soluções Cardioplégicas/administração & dosagem , Modelos Animais de Doenças , Lidocaína/administração & dosagem , Magnésio/administração & dosagem , Masculino , Ressuscitação/mortalidade , Choque Hemorrágico/mortalidade , Suínos , Ferimentos e Lesões/mortalidade
2.
J Cardiothorac Vasc Anesth ; 33(5): 1197-1204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30655202

RESUMO

OBJECTIVE: To compare myocardial protection with retrograde cardioplegia alone with antegrade and retrograde cardioplegia in minimally invasive mitral valve surgery (MIMS). DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: The authors studied 97 MIMS patients using retrograde cardioplegia alone and 118 MIMS patients using antegrade and retrograde cardioplegia. INTERVENTIONS: The data from patients admitted for MIMS using retrograde cardioplegia (MIMS retro) between 2009 to 2012 were compared with the data from patients undergoing MIMS with antegrade and retrograde cardioplegia (MIMS ante-retro) between 2006 and 2010 (control group). Cardioplegia in the MIMS retro group was delivered solely through an endovascular coronary sinus (CS) catheter positioned under echographic and fluoroscopic guidance. Antegrade and retrograde cardioplegia was used in the MIMS ante-retro group. Data regarding myocardial infarction (MI; creatine kinase Mb, troponin T, electrocardiogram), myocardial function, and hemodynamic stability were collected for comparison. MEASUREMENTS AND MAIN RESULTS: Adequate cardioplegia administration (CS pressure >30 mmHg and asystole) was attained in 74.2% of the patients with retrograde cardioplegia alone. In 23.7% of the patients, the addition of an antegrade cardioplegia was necessary. No difference was observed in the incidence of MI (0 MIMS retro v 1 for MIMS ante-retro, p = 0.3623), difficult separation from cardiopulmonary bypass, and postoperative malignant arrhythmia. No difference was found for maximal creatine kinase Mb (39.1 [28.0-49.1] v 37.9 [28.6-50.9]; p = 0.8299) and for maximal troponin T levels (0.39 [0.27-0.70] v 0.47 [0.32-0.79]; p = 0.1231) for MIMS retro and MIMS ante-retro, respectively. However, lactate levels in the MIMS retro group were significantly lower than in the MIMS ante-retro group (2.1 [1.4-3.05] v 2.4 [1.8-3.3], respectively; p = 0.0453). No difference was observed in duration of intensive care unit stay and death. MIMS retro patients had a shorter hospital stay (7.0 [6.0-8.0] v 8.0 [7.0-9.0] days; p = 0.0003). CONCLUSION: Retrograde cardioplegia administration alone provided comparable myocardial protection to antegrade and retrograde cardioplegia during MIMS, but was not sufficient to achieve asystole in one-fifth of patients.


Assuntos
Cateterismo Cardíaco/métodos , Seio Coronário/cirurgia , Procedimentos Endovasculares/métodos , Parada Cardíaca Induzida/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Adulto , Idoso , Cateterismo Cardíaco/normas , Soluções Cardioplégicas/administração & dosagem , Terapia Combinada/métodos , Terapia Combinada/normas , Procedimentos Endovasculares/normas , Feminino , Parada Cardíaca Induzida/normas , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Estudos Retrospectivos
3.
Thorac Cardiovasc Surg ; 67(6): 475-483, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30049018

RESUMO

BACKGROUND: Crystalloid priming is a cost-effective, free from immunological reactions, and independent from human plasma delivery. However, there is some debate on the negative impact of low plasma colloid pressure and higher incidence of systemic inflammatory response syndrome (SIRS). The aim of the study was to rule out any adverse effects of crystalloid priming on the postoperative outcome. METHODS: We investigated 520 consecutive patients, including emergencies, who had isolated on-pump coronary artery bypass grafting in 2009 by retrospective analysis in our clinic. Crystalloid priming (n = 294) was introduced as an alternative to albumin (n = 226). Reviewing patient charts and IT-based data generated a dataset of perioperative parameters. RESULTS: There were no differences with respect to demographical data and preexisting comorbidities between both groups. Despite equal perfusion times, more volume had to be substituted during extracorporeal circulation following crystalloid priming. However, this did not influence the inhospital outcomes. According to the definition of the "Sepsis-3 Guidelines," the incidence of SIRS was similar. There was no difference in the need for a vasopressor treatment, and only transient higher serum lactate levels were found in the crystalloid group. The incidence of neurologic and organ-related adverse events, as well as 30-day mortality was comparable. CONCLUSION: The use of crystalloid priming is safe in coronary artery bypass grafting surgery in adults. However, there might be a greater need for crystalloid fluids during surgery.


Assuntos
Albuminas/administração & dosagem , Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária , Circulação Extracorpórea/instrumentação , Máquina Coração-Pulmão , Compostos de Potássio/administração & dosagem , Idoso , Albuminas/efeitos adversos , Soluções Cardioplégicas/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Circulação Extracorpórea/efeitos adversos , Circulação Extracorpórea/mortalidade , Feminino , Alemanha/epidemiologia , Glucose/administração & dosagem , Glucose/efeitos adversos , Máquina Coração-Pulmão/efeitos adversos , Humanos , Incidência , Masculino , Manitol/administração & dosagem , Manitol/efeitos adversos , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/efeitos adversos , Compostos de Potássio/efeitos adversos , Procaína/administração & dosagem , Procaína/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Fatores de Tempo , Resultado do Tratamento
4.
Ann Thorac Cardiovasc Surg ; 25(1): 10-17, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30158392

RESUMO

PURPOSE: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery. METHODS: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (T1), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level. RESULTS: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2. CONCLUSION: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária , Células Endoteliais/efeitos dos fármacos , Glicocálix/efeitos dos fármacos , Parada Cardíaca Induzida/métodos , Estresse Oxidativo/efeitos dos fármacos , Compostos de Potássio/administração & dosagem , Produtos da Oxidação Avançada de Proteínas/sangue , Idoso , Biomarcadores/sangue , Soluções Cardioplégicas/efeitos adversos , Temperatura Baixa , Ponte de Artéria Coronária/efeitos adversos , Creatina Quinase Forma MB/sangue , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Feminino , Glicocálix/metabolismo , Glicocálix/patologia , Parada Cardíaca Induzida/efeitos adversos , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Ácido N-Acetilneuramínico/sangue , Compostos de Potássio/efeitos adversos , Estudos Prospectivos , Albumina Sérica Humana , Compostos de Sulfidrila/sangue , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Turquia
5.
Thorac Cardiovasc Surg ; 67(6): 484-487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30071564

RESUMO

We studied myocardial protection during coronary artery bypass graft surgery using low-volume cardioplegia (Cardioplexol) and minimal extracorporeal circulation (MECC) for different types of coronary artery diseases. In total, 426 consecutive patients were included and divided into four groups: those with left main stem stenosis (n = 45), those with three-vessel disease (n = 200), those with both (n = 141), and those with neither (n = 40). The peak postoperative myocardial markers and 30-day mortality were analyzed. Both myocardial markers and 30-day mortality were significantly elevated in patients with isolated main stem stenosis. We conclude that the use of low-volume cardioplegia and MECC is safe. However, patients with underlying isolated left main stem stenosis might be less protected.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária , Estenose Coronária/cirurgia , Circulação Extracorpórea/métodos , Parada Cardíaca Induzida/métodos , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Compostos de Potássio/administração & dosagem , Biomarcadores/sangue , Soluções Cardioplégicas/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Estenose Coronária/sangue , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Creatina Quinase Forma MB/sangue , Bases de Dados Factuais , Circulação Extracorpórea/efeitos adversos , Circulação Extracorpórea/mortalidade , Feminino , Parada Cardíaca Induzida/efeitos adversos , Parada Cardíaca Induzida/mortalidade , Humanos , Masculino , Traumatismo por Reperfusão Miocárdica/sangue , Traumatismo por Reperfusão Miocárdica/diagnóstico , Traumatismo por Reperfusão Miocárdica/mortalidade , Compostos de Potássio/efeitos adversos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Troponina T/sangue
6.
Braz J Cardiovasc Surg ; 33(5): 496-504, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517259

RESUMO

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.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária/métodos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Ther Adv Cardiovasc Dis ; 12(10): 263-273, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30081729

RESUMO

BACKGROUND: We analyzed the adequacy of the myocardial protection achieved with a single dose of retrograde crystalloid Celsior®, compared with an accepted standard (microplegia), in on-pump coronary artery bypass grafting surgery (CABG). METHODS: This was a retrospective comparative clinical study conducted in a single institution that included all the patients operated on who had elective isolated on-pump CABG, from March 2006 to June 2014. We evaluated maximum postoperative troponin T (TnT) as a marker of myocardial damage, adjusted for possible confounders using propensity score matching. We also analyzed markers of recovery of myocardial function, and the safety of the intravenous use of Celsior®. RESULTS: During the study period, 261 patients were included, divided in two groups: (a) continuous retrograde blood-based microplegia (114 patients); (b) retrograde single-dose crystalloid Celsior® (147 patients). The propensity score adjusted maximum TnT was significantly lower in the Celsior group [average treatment effect = -0.55 ng/dl; 95% confidence interval (CI) -1.10 to -0.1 ng/dl; p = 0.048]. There were no differences in the postoperative use of intra-aortic balloon of counterpulsation or in the requirements of high-dose inotropic medications. In-hospital mortality was equivalent in both study groups ( p = 0.73); surgical re-exploration because of bleeding was equivalent ( p = 0.37). There were no differences in prolonged mechanical ventilation ( p = 0.65) and intensive care unit length of stay ( p = 0.87). CONCLUSION: An isolated single dose of retrograde Celsior® may be an effective and safe myocardial protection strategy in on-pump CABG.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Parada Cardíaca Induzida/métodos , Soluções Isotônicas/administração & dosagem , Idoso , Biomarcadores/sangue , Soluções Cardioplégicas/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Soluções Cristaloides , Dissacarídeos/administração & dosagem , Dissacarídeos/efeitos adversos , Eletrólitos/administração & dosagem , Eletrólitos/efeitos adversos , Feminino , Glutamatos/administração & dosagem , Glutamatos/efeitos adversos , Glutationa/administração & dosagem , Glutationa/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Parada Cardíaca Induzida/mortalidade , Histidina/administração & dosagem , Histidina/efeitos adversos , Mortalidade Hospitalar , Humanos , Soluções Isotônicas/efeitos adversos , Modelos Logísticos , Masculino , Manitol/administração & dosagem , Manitol/efeitos adversos , Pessoa de Meia-Idade , Miocárdio/metabolismo , Miocárdio/patologia , Razão de Chances , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Espanha , Resultado do Tratamento , Troponina T/sangue
8.
Ann Thorac Surg ; 106(5): 1379-1387, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30028983

RESUMO

BACKGROUND: During cardiac surgery with cardiopulmonary bypass, delivery of cardioplegia solution to achieve electromechanical cardiac quiescence is obligatory. The addition of lidocaine to cardioplegia has advantages, although its consequences at a molecular level remain unclear. We performed whole-genome RNA sequencing of the human left ventricular (LV) myocardium to elucidate the differences between whole-blood (WB) cardioplegia with and without addition of lidocaine (LC) on gene expression. METHODS: We prospectively enrolled 130 patients undergoing aortic valve replacement surgery. Patients received high-potassium blood cardioplegia either with (n = 37) or without (n = 93) lidocaine. The LV apex was biopsied at baseline, and after an average of 74 minutes of cold cardioplegic arrest. We performed differential gene expression analysis for 18,258 genes between these 2 groups. Clinical and demographic variables were adjusted in the model. Gene ontology (GO) and network enrichment analysis of the retained genes were performed using g:Profiler and Cytoscape. RESULTS: A total of 1,298 genes were differentially expressed between cardioplegic treatments. Compared with the WB group, genes upregulated in the LC group were identified by network enrichment to play a protective role in ischemic injury by inhibiting apoptosis, increasing transferrin endocytosis, and increasing cell viability. Downregulated genes in the LC group were identified to play a role in inflammatory diseases, oxygen transport, and neutrophil aggregation. CONCLUSIONS: The addition of lidocaine to cardioplegia had pronounced effects on a molecular level with genes responsible for decreased inflammation, reduced intracellular calcium binding, enhanced antiapoptotic protection, augmented oxygen accessibility through transferrins, and increased cell viability showing measurable differences.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Parada Cardíaca Induzida/métodos , Implante de Prótese de Valva Cardíaca/métodos , Lidocaína/administração & dosagem , Centros Médicos Acadêmicos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar/métodos , Ponte Cardiopulmonar/mortalidade , Estudos de Coortes , Regulação da Expressão Gênica , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Biologia Molecular , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
9.
Eur J Cardiothorac Surg ; 54(3): 539-546, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29547976

RESUMO

OBJECTIVES: Previous studies demonstrated that preconditioning with argon gas provided a marked reduction in inflammation and apoptosis and increased myocardial contractility in the setting of acute myocardial ischaemia-reperfusion (IR). There is substantial evidence that myocardial IR injury following cardioplegic arrest is associated with the enhancement of apoptosis and inflammation, which is considered to play a role in cardiac functional impairment. Therefore, the present study was designed to clarify whether preconditioning with argon gas enhances recovery of cardiac function following cardioplegic arrest. METHODS: Sprague-Dawley rats were anaesthetized and ventilated and allocated to (i) the control group (control IR, n = 10) and (ii) the in vivo group (argon IR), which received 3 cycles of argon (50% argon, 21% oxygen and 29% nitrogen, n = 10) administered for 5 min interspersed with 5 min of a gas mixture (79% nitrogen and 21% oxygen). The hearts were excised and then evaluated in an erythrocyte-perfused isolated working heart system. Cold ischaemia (4°C) for 60 min was induced by histidine-tryptophan-ketoglutarate cardioplegia, followed by 40 min of reperfusion. Cardiac functional parameters were assessed. In left ventricular tissue samples, the expressions of extracellular-regulated kinase (ERK1/2), AKT serine/threonine kinase (Akt), jun N-terminal kinase (JNK), endothelial nitric oxide synthase (eNOS) and HMGB1: high-mobility group box 1 (HMGB1) protein were assessed by western blot, and high-energy phosphates were evaluated by high-performance liquid chromatography. RESULTS: At the end of reperfusion, the rats preconditioned with argon showed significantly enhanced recovery of cardiac output (101 ± 6% vs 87 ± 11%; P < 0.01), stroke volume (94 ± 4% vs 80 ± 11%; P = 0.001), external heart work (100 ± 6% vs 81 ± 13%; P < 0.001) and coronary flow (90 ± 13% vs 125 ± 21%; P < 0.01) compared with the control IR group. These results were accompanied by a significant increase in the levels of myocardial phosphocreatine (23.71 ± 2.07 µmol/g protein vs the control IR group, 13.50 ± 4.75; P = 0.001) and maintained adenosine triphosphate levels (13.62 ±1.89 µmol/g protein vs control IR group adenosine triphosphate: 10.08 ± 1.94 µmol/g; P = 0.017). Additionally, preconditioning with argon markedly reduced the activation of JNK (0.11 ± 0.01 vs 0.25 ± 0.03; P = 0.005) and the expression of HMGB1 protein (0.52 ± 0.04 vs 1.5 ± 0.10; P < 0.001) following reperfusion. CONCLUSIONS: Preconditioning with argon enhanced cardiac functional recovery in rat hearts arrested with histidine-tryptophan-ketoglutarate cardioplegia, thereby representing a potential novel cardioprotective approach in cardiac surgery.


Assuntos
Argônio/farmacologia , Soluções Cardioplégicas/farmacologia , Cardiotônicos/farmacologia , Parada Cardíaca Induzida/métodos , Precondicionamento Isquêmico Miocárdico/métodos , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Administração por Inalação , Animais , Argônio/administração & dosagem , Soluções Cardioplégicas/administração & dosagem , Cardiotônicos/administração & dosagem , Coração/efeitos dos fármacos , Masculino , Traumatismo por Reperfusão Miocárdica/metabolismo , Miocárdio/química , Miocárdio/metabolismo , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
10.
J Card Surg ; 33(5): 229-234, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29444545

RESUMO

A variety of cardioplegic solutions are being used widely today to arrest the heart during coronary artery bypass grafting (CABG) and other cardiac operations. To minimize interruptions during the surgery for intermittent dosing of the cardioplegia and to facilitate less invasive cardiac procedures, single-shot solutions, including Bretschneider and del Nido solutions, have been introduced. This review examines the evidence regarding the safety and efficacy of Bretschneider and del Nido cardioplegia during CABG. The findings support their use in routine low-risk CABG, but finds insufficient evidence to support their safety in high-risk surgeries.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária , Parada Cardíaca Induzida/métodos , Procedimentos Cirúrgicos Cardíacos , Humanos , Risco , Segurança , Volume Sistólico
11.
Asian Cardiovasc Thorac Ann ; 26(3): 196-202, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29448828

RESUMO

Introduction Myocardial protection is vital to ensure successful open heart surgery. Cardioplegic solution is one method to achieve good myocardial protection. Inevitably, ischemia-reperfusion injury occurs with aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a frequently used cardioplegia for complex congenital heart surgery. We postulated that addition of terminal warm blood cardioplegia before removal of the aortic crossclamp might improve myocardial protection. Method A randomized controlled trial was conducted on 109 cyanotic patients aged, 1 to 5 years who underwent complex biventricular repair. They were divided into a control group of 55 patients who had histidine-tryptophan-ketoglutarate only and a treatment group of 54 who had histidine-tryptophan-ketoglutarate with terminal warm blood cardioplegia. Endpoints were clinical parameters, troponin I levels, and caspase-3 as an apoptosis marker. Results The incidence of low cardiac output syndrome was 34%, with no significant difference between groups (35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment group was lower compared to the control group (36% vs. 12%, p = 0.005). Troponin I and caspase-3 results did not show any significant differences between groups. For cases with Aristotle score ≥ 10, weak expression of caspase-3 in the treatment group post-cardiopulmonary bypass was lower compared to the control group. Conclusion For complex congenital cardiac surgery, the addition of terminal warm blood cardioplegia does not significantly improve postoperative clinical or metabolic markers.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Parada Cardíaca Induzida/métodos , Cardiopatias Congênitas/cirurgia , Temperatura Ambiente , Apoptose , Arritmias Cardíacas/etiologia , Biomarcadores/sangue , Baixo Débito Cardíaco/etiologia , Soluções Cardioplégicas/efeitos adversos , Caspase 3/análise , Pré-Escolar , Feminino , Glucose/administração & dosagem , Glucose/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Indonésia , Lactente , Masculino , Manitol/administração & dosagem , Manitol/efeitos adversos , Miocárdio/química , Miocárdio/patologia , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/efeitos adversos , Procaína/administração & dosagem , Procaína/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue
12.
Anesth Analg ; 126(4): 1133-1141, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29324494

RESUMO

BACKGROUND: Low cardiac output syndrome is a main cause of death after cardiac surgery. We sought to assess the impact of glucose-insulin-potassium (GIK) to enhance myocardial protection in moderate- to high-risk patients undergoing on-pump heart surgery. METHODS: A randomized controlled trial was performed in adult patients (Bernstein-Parsonnet score >7) scheduled for elective aortic valve replacement and/or coronary artery bypass surgery. Patients were randomized to GIK (20 IU of insulin, 10 mEq of potassium chloride in 50 mL of glucose 40%) or saline infusion given over 60 minutes on anesthetic induction. The primary end point was postcardiotomy ventricular dysfunction (PCVD), defined as new/worsening left ventricular dysfunction requiring inotropic support (≥120 minutes). Secondary end points were the intraoperative changes in left ventricular function as assessed by transoesophageal echocardiography, postoperative troponin levels, cardiovascular and respiratory complications, and intensive care unit and hospital length of stay. RESULTS: From 224 randomized patients, 222 were analyzed (112 and 110 in the placebo and GIK groups, respectively). GIK pretreatment was associated with a reduced occurrence of PCVD (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.25-0.66). In GIK-treated patients, the left systolic ventricular function was better preserved after weaning from bypass, plasma troponin levels were lower on the first postoperative day (2.9 ng·mL(-) [interquartile range {IQR}, 1.5-6.6] vs 4.3 ng·mL(-) [IQR, 2.4-8.2]), and cardiovascular (RR, 0.69; 95% CI, 0.50-0.89) and respiratory complications (RR, 0.5; 95% CI, 0.38-0.74) were reduced, along with a shorter length of stay in intensive care unit (3 days [IQR, 2-4] vs 3.5 days [IQR, 2-7]) and in hospital (14 days [IQR, 11-18.5] vs 16 days [IQR, 12.5-23.5]), compared with placebo-treated patients. CONCLUSIONS: GIK pretreatment was shown to attenuate PCVD and to improve clinical outcome in moderate- to high-risk patients undergoing on-pump cardiac surgery.


Assuntos
Baixo Débito Cardíaco/prevenção & controle , Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar , Ponte de Artéria Coronária , Parada Cardíaca Induzida/métodos , Implante de Prótese de Valva Cardíaca , Disfunção Ventricular Esquerda/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Débito Cardíaco , Baixo Débito Cardíaco/diagnóstico por imagem , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/fisiopatologia , Soluções Cardioplégicas/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Glucose/administração & dosagem , Glucose/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Infusões Intravenosas , Insulina/administração & dosagem , Insulina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Potássio/administração & dosagem , Potássio/efeitos adversos , Fatores de Risco , Suíça , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
13.
Thorac Cardiovasc Surg ; 66(6): 457-463, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29290079

RESUMO

BACKGROUND: Choice of cardioplegic solution plays a pivotal role in special subgroups of patients referred for on-pump cardiac surgery. This retrospective analysis aimed to assess the impact of intermittent warm (Calafiore, Cala) versus intermittent cold blood cardioplegia (Buckberg, Buck) in patients referred to coronary artery bypass graft (CABG) surgery due to acute coronary syndromes (ACS). METHODS: From 2008 to 2015, all consecutive patients undergoing urgent on-pump CABG surgery due to ACS (n = 950) were retrospectively analyzed. Intraoperative cardiac arrest was achieved using Buck (n = 273) or Cala (n = 677). Patients were compared regarding clinical outcomes and perioperative myocardial injury (PMI). Propensity score matching was performed to control for differences in preoperative patient characteristics. RESULTS: Prevalences of left main stenosis >50%, COPD, and advanced New York Heart Association (NYHA) class were higher for intermittent warm blood cardioplegia (IWC)-patients while more Buck-patients had preoperative intra-aortic balloon pump (IABP) and redo procedures. Buck-patients needed more intraoperative defibrillations and showed longer cardiopulmonary bypass (CPB) and aortic clamping times. 30-day all-cause mortality (10.6 versus 9.3%), major adverse cardiac events (MACE) (52.7 versus 48.6%), and PMI (50.5 versus 55.7%; all p > 0.05) rates were comparable for Buck- and Cala-patients. Propensity score matching resulted in equal group sizes (n = 212 each) and balanced distribution of preoperative covariates. Although more Buck-patients still needed inotropic support >24 hours postoperatively (25.7 versus 14.7%; p = 0.005) compared with Cala-group, outcome variables of interest did not differ between treatment groups (30-day mortality: 7.5 versus 9.0%; MACE: 49.5 versus 40.6%; PMI: 48.1 versus 37.3%; all p > 0.05). CONCLUSION: Buckberg and Calafiore cardioplegia offer comparable myocardial protection and similar postoperative results in patients undergoing CABG surgery due to ACS.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Parada Cardíaca Induzida/métodos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Soluções Cardioplégicas/efeitos adversos , Ponte Cardiopulmonar , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Estenose Coronária/diagnóstico , Estenose Coronária/mortalidade , Estenose Coronária/fisiopatologia , Feminino , Parada Cardíaca Induzida/efeitos adversos , Parada Cardíaca Induzida/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Temperatura Ambiente , Fatores de Tempo , Resultado do Tratamento
14.
Eur J Cardiothorac Surg ; 53(3): 664-671, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29069350

RESUMO

OBJECTIVES: Several studies have reported superior post-cardioplegic recovery after glutamate supplementation. The optimum dose of glutamate supplementation is unknown. The purpose of this study was to find the optimal protective concentration of glutamate supplementation in a model of ischaemia/cardioplegia and reperfusion. METHODS: Isolated rat hearts (n = 77) were perfused with the Krebs-Henseleit buffer. After stabilization, the hearts were subjected to 25 min of normothermic ischaemia followed by a single 3-min infusion of cold (4-6 °C) St. Thomas' Hospital II cardioplegia and 87 min of cardioplegic ischaemic arrest and 60 min of reperfusion. Sodium-l-glutamate was added to the perfusate (control group had zero glutamate) in increasing concentrations (0.01, 0.1, 1, 10, 20, 30 and 100 mM) and given throughout perfusion. Corresponding concentrations were added to the cardioplegic solution. A balloon in the left ventricle inserted via the left atrium measured left ventricular pressures isometrically. Left ventricular developed pressure was calculated. Myocardial exchange of glucose and lactate was measured prior to ischaemia and during reperfusion. Myocardial content of glycogen and glutamate was measured at the end of reperfusion. RESULTS: During reperfusion left ventricular developed pressure increased (P < 0.0001) in groups supplemented with 0.1, 1.0, 10, 20 and 30 mM glutamate, whereas left ventricular end-diastolic pressure was attenuated (P = 0.008) when compared with the controls. No additional benefit on the continuous data left ventricular developed pressure and left ventricular end-diastolic pressure was observed with glutamate concentrations above 1 mM. Onset of LV pressure rise during the period of ischaemia was delayed by 100 mM of glutamate (P = 0.02). Myocardial content of glutamate was increased in a dose-related manner in Groups 10, 20, 30 and 100 compared with the control hearts (P < 0.0001). Glycogen was increased in the hearts supplemented with 100 mM of glutamate (P = 0.02). CONCLUSIONS: Even low concentrations of l-glutamate improved postischaemic and post-cardioplegic heart function and 1 mM seems to be optimal.


Assuntos
Soluções Cardioplégicas/farmacologia , Ácido Glutâmico/farmacologia , Parada Cardíaca Induzida/métodos , Isquemia Miocárdica/metabolismo , Animais , Soluções Cardioplégicas/administração & dosagem , Temperatura Baixa , Relação Dose-Resposta a Droga , Ácido Glutâmico/administração & dosagem , Coração/efeitos dos fármacos , Masculino , Ratos , Ratos Sprague-Dawley , Pressão Ventricular/efeitos dos fármacos
15.
Perfusion ; 33(5): 363-366, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29272987

RESUMO

BACKGROUND: The isolated heart apparatus is over 100 years old, but remains a useful research tool today. While designs of many large animal systems have been described in the literature, trouble-shooting and refining such a model to yield a stable, workable system has not been previously described. This paper outlines the issues, in tabular form, that our group encountered in developing our own porcine isolated heart rig with the aim of assisting other workers in the field planning similar work. The paper also highlights some of the modern applications of the isolated heart apparatus. Methods Landrace pigs (50-80 kg) were used in a pilot project to develop the model. The model was then used in a study examining the effects of various cardioplegic solutions on function after reanimation of porcine hearts. During the two projects, non-protocol issues were documented as well as their solutions. These were aggregated in this paper. RESULTS: Issues faced by the group without explicit literature solutions included pig size selection, animal acclimatisation, porcine transoesophageal echocardiography, cannulation and phlebotomy for cross-clamping, cardioplegia delivery, heart suspension and rig tuning. CONCLUSION: Prior recognition of issues and possible solutions faced by workers establishing a porcine isolated heart system will speed progress towards a useable system for research. The isolated heart apparatus remains applicable in transplant, ischaemia reperfusion, heart failure and organ preservation research.


Assuntos
Coração/fisiologia , Preparação de Coração Isolado/instrumentação , Perfusão/instrumentação , Suínos/fisiologia , Animais , Soluções Cardioplégicas/administração & dosagem , Desenho de Equipamento , Parada Cardíaca Induzida/instrumentação , Parada Cardíaca Induzida/métodos , Preparação de Coração Isolado/métodos , Preservação de Órgãos/instrumentação , Preservação de Órgãos/métodos , Perfusão/métodos , Projetos Piloto
16.
J Thorac Cardiovasc Surg ; 155(3): 1011-1018, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29246552

RESUMO

OBJECTIVES: The del Nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. This randomized controlled trial examined whether expanding this technique to adult cardiac surgery confers benefits in surgical workflow and clinical outcome compared with blood-based cardioplegia. METHODS: Adult first-time coronary artery bypass grafting (CABG), valve, or CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia (n = 41). Primary outcomes assessed myocardial preservation. Troponin I was measured at baseline, 2 hours after CPB termination, 12 and 24 hours after cardiovascular intensive care unit admission. Alpha was set at P < .001. RESULTS: Preoperative characteristics were similar between groups, including age, Society of Thoracic Surgeons risk score, CABG, and valve procedures. There was no significant difference on CPB time (97 vs 103 minutes; P = .288) or crossclamp time (70 vs 83 minutes; P = .018). The del Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%; P = .023) and fewer patients required inotropic support (65.1% vs 84.2%; P = .050), but did not reach statistical significance. Incidence of Society of Thoracic Surgeons-defined morbidity was low, with no strokes, myocardial infarctions, renal failure, or operative deaths. For del Nido group patients, troponin levels did not increase as much as for control patients (P = .040), but statistical significance was not reached. CONCLUSIONS: Evidence from this study suggests del Nido cardioplegia use in routine adult cases may be safe, result in comparable clinical outcomes, and streamline surgical workflow. The trend for troponin should be investigated further because it may suggest superior myocardial protection with the del Nido solution.


Assuntos
Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar , Ponte de Artéria Coronária/métodos , Parada Cardíaca Induzida/métodos , Valvas Cardíacas/cirurgia , Idoso , Biomarcadores/sangue , Soluções Cardioplégicas/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Feminino , Parada Cardíaca Induzida/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Admissão do Paciente , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Fluxo de Trabalho
17.
Campinas; s.n; 2018. 71 p. ilus, tab, graf.
Tese em Português | LILACS | ID: biblio-913911

RESUMO

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)


Assuntos
Animais , Soluções Cardioplégicas , Parada Cardíaca , Isquemia , Reperfusão Miocárdica , Baixo Débito Cardíaco , Soluções Cardioplégicas/administração & dosagem , Coração , Período Pós-Operatório , Ratos Wistar
19.
BMJ Case Rep ; 20172017 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-29021143

RESUMO

Cold agglutinins are autoantibodies that agglutinate red blood cells at low temperatures, leading to haemagglutination and haemolysis. They are generally of no clinical significance. However, when people with cold agglutinins undergo cardiac operation with hypothermia and cold cardioplegia, they can experience complications. Thus, different perioperative management is required for such patients. We describe a 74-year-old man with cold agglutinins incidentally detected on the preoperative screening test. He had never experienced any complications or developed a haematological disease. Since cold agglutinins were incidentally detected on the preoperative test, a special strategy was used to manage the temperature of cardiopulmonary bypass (CPB) and cardioplegia. He successfully underwent normothermic cardiac operation with warm cardioplegia. A continuous retrograde hyperkalaemic infusion and intermittent antegrade infusion of warm cardioplegia with normothermic CPB is one of the best methods to avoid hypothermia and excessive activity and metabolism of the heart, and to provide a suitable operative field.


Assuntos
Anemia Hemolítica Autoimune/complicações , Ponte Cardiopulmonar/métodos , Parada Cardíaca Induzida/métodos , Hipotermia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Idoso , Anemia Hemolítica Autoimune/diagnóstico , Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar/efeitos adversos , Crioglobulinas/análise , Parada Cardíaca Induzida/efeitos adversos , Humanos , Hipotermia/etiologia , Achados Incidentais , Masculino , Complicações Pós-Operatórias/etiologia , Temperatura Ambiente
20.
Innovations (Phila) ; 12(5): 356-362, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29016380

RESUMO

OBJECTIVE: del Nido solution (DNS) is a single-dose cardioplegia designed for pediatric use proposed to offer superior myocardial protection in adults. However, few data support this claim. We hypothesized that DNS and modified blood cardioplegia solution (BS) provide equivalent safety in combined adult valve surgery. METHODS: Between November 2014 and December 2015, 25 patients underwent primary aortic valve replacement and concomitant coronary artery bypass grafting (CABG) with DNS. Outcomes were compared with 25 patients who underwent the same surgery with BS between September 2013 and August 2015. RESULTS: All preoperative characteristics, comorbidities, and number of CABG performed were similar between groups. One hospital death occurred in the BS group. Postoperative creatine kinase, MB isotype (16.7 ± 5.3 µg/L vs. 22.1 ± 8.9 µg/L, P = 0.011) and troponin T levels (260 ± 105.3 ng/L vs. 370.5 ± 218.4 ng/L, P = 0.028) were significantly lower in the DNS group. There was no difference in inotropic or vasoactive agent use (P = 0.512). Cardiopulmonary bypass times (65.5 ± 12.5 min vs. 76.6 ± 19.1 min, P = 0.019) and cross-clamp times (55.6 ± 11.2 min vs. 64.3 ± 18.9 min, P = 0.05) were lower in the DNS group but total operating room times (P = 0.198) were similar. Peak postoperative creatinine levels were similar in both groups (P = 0.063). There was no difference in postoperative outcomes including acute renal failure (P > 0.999), atrial fibrillation (P = 0.773), acute respiratory failure (P > 0.999), nor stroke or transient ischemic attack (P > 0.999). Intensive care unit stay (P = 0.213) and hospital stay (P = 0.1) did not differ between groups. CONCLUSIONS: The DNS can be used as an alternative to BS in adult concomitant aortic valve replacement + CABG surgery. This supports our hypothesis that in this specific setting, DNS provides comparable myocardial protection as BS, with possibly shorter cardiopulmonary bypass and cross-clamp times.


Assuntos
Valva Aórtica/cirurgia , Soluções Cardioplégicas/administração & dosagem , Soluções Cardioplégicas/farmacologia , Parada Cardíaca Induzida/métodos , Procedimentos Cirúrgicos Torácicos/tendências , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Soluções Cardioplégicas/efeitos adversos , Ponte Cardiopulmonar/estatística & dados numéricos , Ponte de Artéria Coronária/métodos , Creatina Quinase Forma MB/metabolismo , Feminino , Parada Cardíaca Induzida/efeitos adversos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Isquemia Miocárdica/prevenção & controle , Miocárdio/metabolismo , Duração da Cirurgia , Período Perioperatório , Período Pós-Operatório , Procedimentos Cirúrgicos Torácicos/métodos , Troponina T/metabolismo
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