Warm reperfusion as an adjunct to myocardial protection

Abstract

We congratulate Hendrikx and colleagues for their work entitled “Release of Cardiac Troponin I in Antegrade Crystalloid Versus Cold Blood Cardioplegia” (J Thorac Cardiovasc Surg 1999;118:452-9). Their conclusions concur with most of the results of our previous studies on this subject.1Etievent JP Chocron S Toubin G Taberlet C Alwan K Clement F et al.Use of cardiac troponin I as a marker of peri-operative myocardial ischemia.Ann Thorac Surg. 1995; 59: 1192-1194Abstract Full Text PDF PubMed Scopus (157) Google Scholar, 2Pichon H Chocron S Alwan K Toubin G Kaili D Falcoz P et al.Crystalloid versus cold blood cardioplegia and cardiac troponin I release.Circulation. 1997; 96: 316-320PubMed Google Scholar We would like to emphasize two points we consider to be important. We, too, have shown cardiac troponin I release to be higher with antegrade crystalloid cardioplegia in patients with main stem stenosis.3Chocron S Alwan K Toubin G Clement F Kaili D Taberlet C et al.Crystalloid cardioplegia route of delivery and cardiac troponin I release.Ann Thorac Surg. 1996; 62: 481-485Abstract Full Text PDF PubMed Scopus (7) Google Scholar Hendrikx and colleagues, in addition to confirming the results of our study on warm reperfusion and myocardial protection,4Chocron S Alwan K Yan Y Toubin G Kaili D Anguenot T et al.Warm reperfusion and myocardial protection.Ann Thorac Surg. 1998; 66: 2003-2007Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar have shed new light on the interest of adding warm reperfusion to myocardial protection. Our comparison of crystalloid to cold blood cardioplegia with warm reperfusion showed the second option to be better.2Pichon H Chocron S Alwan K Toubin G Kaili D Falcoz P et al.Crystalloid versus cold blood cardioplegia and cardiac troponin I release.Circulation. 1997; 96: 316-320PubMed Google Scholar When we compared crystalloid with warm reperfusion to cold blood with warm reperfusion,4Chocron S Alwan K Yan Y Toubin G Kaili D Anguenot T et al.Warm reperfusion and myocardial protection.Ann Thorac Surg. 1998; 66: 2003-2007Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar we found the myocardial protection provided by these two methods to be similar. We concluded that the comparison of the results of these two studies suggested “that much is to be gained by adding warm reperfusion to crystalloid cardioplegia.”4Chocron S Alwan K Yan Y Toubin G Kaili D Anguenot T et al.Warm reperfusion and myocardial protection.Ann Thorac Surg. 1998; 66: 2003-2007Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Hendrikx and colleagues show cold blood cardioplegia with no warm reperfusion to provide myocardial protection equivalent to that of crystalloid cardioplegia with no warm reperfusion and, hence, emphasize the benefit of completing cardioplegia with warm reperfusion. Hendrikx and colleagues provide one more argument to encourage users of crystalloid or cold blood cardioplegia to complete it with warm reperfusion.