Abstract
Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5).Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0−T5 in all the functional microcirculatory parameters [%ΔTVDT0−T5(CCG): −10.86 ± 2.323 vs. %ΔTVDT0−T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0−T5(CCG): −12.91 ± 2.884 vs. %ΔPVDT0−T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0−T5(CCG): −2.345 ± 1.049 vs. %ΔPPVT0−T5(BCG): 1.482 ± 0.576, p < 0.01].Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.
Highlights
The use of cardiopulmonary bypass (CPB) is associated with a wide range of stressors affecting the microvascular system [1]
Since no data are available on the precise influence of cardioplegia type on these CPB-induced microcirculatory alterations, we investigated whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB
From 24 patients enrolled in this study, 20 patients assigned for crystalloid cardioplegia group (CCG) (n = 10) or blood cardioplegia group (BCG) (n = 10) had recordings of good or acceptable quality to perform adequate image analysis (Figure 1)
Summary
The use of cardiopulmonary bypass (CPB) is associated with a wide range of stressors affecting the microvascular system [1]. Many factors during CPB, such as contact of the blood components with the artificial surface of the CPB circuit, ischemia-reperfusion injury (IRI) of the heart, or the release of endotoxins, have been reported to induce a systemic inflammatory response [2] This syndrome results in the activation of the innate immune system via inflammatory mediators, which, in turn, leads to the recruitment of leukocytes into sites of inflammation, thereby causing endothelial injury [2]. The use of blood added to the cardioplegia solution was found to notably optimize the myocardium during the CPB-induced global hypoperfusion and to provide a protective effect on the myocardium under ischemic conditions [4] Beyond this preventive effect, blood cardioplegia appears to attenuate the CPB-induced systemic inflammatory response [5, 6], which may, in turn, affect the microcirculatory perfusion and oxygenation. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB
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