Cardioplegia Group Research Articles

Comparison of Early Outcomes in Del Nido Cardioplegia Versus Conventional Cardioplegia in Term of MP in Patients

Objective: To compare early outcomes in antegrade conventional crystalloid cardioplegia with Del Nido (DN) cardioplegia in term of myocardial protection in patients undergoing CABG. Methodology: All the patients undergoing Coronary artery bypass grafting surgery were enrolled in this study after informed consent. Preoperative, intra-operative and postoperative variables were entered in the pre-designed proforma and patients were followed to compare early outcomes in Del-Nido versus Conventional Cardioplegia. Results: The mean age of the patients in Del Nido group was 54.61 ± 9.129 whereas the mean age of the patients in Conventional Cardioplegia group was 53.91 ± 10.39. There were 50(71.43%) males and 20(28.57%) females in Del-Nido group as compare with Conventional group 52(74.29%) males and 18(25.71%) females in this study. The mean cardioplegia volume given to Del Nido and Conventional Cardioplegia group as (1271.43 ± 447.91 vs 2142.86 ± 584.48 (ml/min) with p-value is <0.005 which shows there is a significant difference of Cardioplegia volume given to both groups. The mean cardiopulmonary bypass time (min) in Del Nido group was 116.87 ± 27.25 and in Conventional Cardioplegia group 106.58 ± 29.19 and the p-value of CPB time was significant 0.004. In our data 6(8.5%) patients from Del Nido Cardioplegia Group suffered from AKI whilst in Conventional Cardioplegia Group there were 7(10%) patients who suffered from AKI. Similarly 3(4.29%) patients from Del Nido Group and 2(2.86%) patients from conventional Cardioplegia Group previously suffered from stroke. Arrhythmia is a disorder of heart that affects the rate or rhythm at which the heart beats. Its p-value is significant (0.05) which shows there is a significant difference of this disorder in both groups Conclusion: There was a significant difference in post-operative complication Arrhythmia in both groups and the need for a lower cardioplegia volume and an uninterrupted procedure are the main advantages of Del Nido (DN) cardioplegia solution, which make it superior from conventional cardioplegia. Keywords: Coronary artery Bypass grafting surgery, Del Nido Cardioplegia, Conventional Cardioplegia, CKMB, Troponin I.

Abstract 10536: Adenosine Triphosphate - Sensitive Potassium Channel Opener Diazoxide Reduces Myocardial Stunning in a Porcine Lad Occlusion Model

Introduction: Adenosine triphosphate - sensitive potassium (K ATP ) channels provide endogenous myocardial protection by coupling cell membrane potential to metabolism, as they are inhibited by ATP and open during times of metabolic stress. Pharmacologic opening of K ATP channels mimics ischemic preconditioning, and diazoxide (DZX) preserves myocardial function following prolonged global ischemia. Hypothesis: We hypothesized that DZX would reduce myocardial stunning after left anterior descending coronary artery (LAD) occlusion followed by global ischemia, similar to a clinical situation of acute myocardial infarction followed by coronary revascularization. Methods: Twelve swine underwent LAD occlusion (30 min), followed by 120 min global ischemia protected with hyperkalemic cardioplegia (CPG) +/- DZX (N=6 each), followed by intermittent CPG (q 20 min), then 60 min reperfusion (RF). Cardiac output (CO), mean time to wean from cardiopulmonary bypass (CPB), left ventricular ejection fraction (LVEF), left ventricular developed pressure (LVDP), caspase - 3 (apoptosis), and infarct size were compared. Results: All 6 animals in the DZX group separated from CPB by 30 min RF whereas only 1 and 4 animals in the CPG group had separated at 15 and 30 min, respectively (Figure). DZX was associated with shorter average time to wean from CPB (17.5 vs 27.0 min, p=0.13) and higher CO at all time points during reperfusion (2.9 vs 1.5 L/min at 30 min RF, p=0.05), however, these were not significantly different. DZX was associated with higher LVEF after 30 minutes of reperfusion (42.5 vs 15.8%, p=0.009; Figure). There were no differences between groups in vasopressor use, infarct size, caspase - 3, or LVDP. Conclusions: DZX reduces myocardial stunning and facilitates separation from CPB following LAD occlusion and subsequent global ischemia in a porcine model. The addition of DZX to hyperkalemic cardioplegia has the potential to reduce myocardial stunning in the clinical setting.

Comparison of Microplegia Solution and Del Nido Cardioplegia Solution in Coronary Artery Bypass Grafting Surgery: Which One is More Effective?

The aim of this study is to compare the efficacy of the microplegia solution and Del Nido cardioplegia solution in coronary artery bypass surgery with clinical, biochemical, and echocardiographic data. Three hundred patients, who underwent coronary artery bypass surgery between January 2017 and January 2020, by the same surgical team were included in the study. Preoperative, operative and postoperative data (cardiac biomarker levels, cross-clamp and CPB times, echocardiographic measurements, etc.) of the patients were compared. In the study, cross-clamp time was significantly shorter in the DN cardioplegia group (55.60 ± 13.49 min/75.58 ± 12.43 min, P = 0.024). No significant difference was observed between the two groups in terms of intensive care stay, extubation time, hospital stay, and cardiopulmonary bypass time. In our study, it was shown that both the left and right ventricular ejection fraction was better protected in the Del Nido cardioplegia group (5.34±3.03 vs. 3.40±2.84, P = 0.017 and 3.82±1.19 vs. 2.28±1.87, P = 0.047, respectively), and the need for inotrope support was lower in this group (28% vs. 44%, P < 0.021). There was no significant difference between the groups, in terms of blood transfusion rates, IABP requirement. In light of short-term results, we can say that Del Nido cardioplegia provides better myocardial protection than microplegia. In addition, Del Nido cardioplegia can be given as a single dose for 90 minutes of cross-clamp time and therefore can be preferred to increase surgical comfort and reduce cross-clamp times.

Effects of Del Nido and Terminal Warm Blood Cardioplegia on Myocardial Protection and Rhythm in Isolated CABG Patients.

To investigate the effect of using del Nido cardioplegia+terminal hot-shot blood cardioplegia on myocardial protection and rhythm in isolated coronary bypass patients. A total of 122 patients were given cold (+4-8C') del Nido cardioplegia antegrade and evaluated. Del Nido+terminal warm blood cardioplegia (TWBCP) was applied to 63 patients out of 122 patients, while del Nido cardioplegia alone was applied to the other 59 patients. The preoperative and postoperative data of the patients were recorded and compared. There was a significant statistical difference between the groups, in terms of volume with more cardioplegia in the del Nido+terminal warm blood cardioplegia group. Although there was no significant difference between cardiac arrest times in both groups, a statistically significant difference was found in the del Nido+terminal warm blood cardioplegia group in the starting to work time of the heart. No difference found between the groups regarding myocardial preservation. We can add a return to spontaneous sinus rhythm to the advantages of terminal warm blood cardioplegia and del Nido cardioplegia in literature. We think it would be a good strategy to extend the safe ischemic time limit of del Nido to 120 minutes with a terminal warm blood cardioplegia. It seems that cardioplegia techniques that will be developed by adding the successful and superior results of crystalloid cardioplegia applications, such as single dose del Nido in various open heart surgery operations and the superior myocardial return effects of terminal warm blood cardioplegia, will be used routinely in the future.

Effect of del nido cardioplegia use on kidney injury after coronary bypass operations.

After cardiac surgery, acute kidney injury is observed at a rate of 5-30%, and the second most common cause of acute kidney injury in intensive care units is cardiac surgery. In this study, we aimed to investigate the effect of del Nido cardioplegia solution use on postoperative acute kidney injury development in patients who underwent coronary artery bypass grafting operation with cardiopulmonary bypass. Consecutive patients who underwent an elective coronary artery bypass grafting operation with cardiopulmonary bypass in our clinic between March 15, 2019, and March 15, 2020, were included in the study retrospectively. The patients were divided into two groups as those who received del Nido cardioplegia solution (Group 1) and blood cardioplegia (Group 2), and factors affecting the development of renal failure were examined. A total of 350 consecutive patients were included in the study. There were 156 patients in the del Nido cardioplegia group and 194 patients in the blood cardioplegia group. Among the patient group, 74 (21.1%) patients developed acute kidney injury. The total acute kidney injury development rate was significantly higher in Group 2 (p=0.018). In multivariate logistic regression analysis, advanced age (OR 1.128; 95%CI 1.044-1.217; p=0.042), increased blood product use (OR 1.318; 95%CI 1.154-1.998; p=0.019), preoperative creatinine elevation (OR 2.434; 95%CI 1.655-4.639; p=0.005), and increased cardioplegia volume (OR 1.254; 95%CI 1.109-2.980; p=0.009) were independent predictors of acute kidney injury. With this study, we showed that the use of del Nido cardioplegia solution can reduce the incidence of acute kidney injury.

Efficacy of Histidine-Tryptophan-Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study.

In cardiac surgery, myocardial protection is required during cross-clamping followed by reperfusion. The use of cardioplegic solutions helps preserve myocardial energy stores, hindering electrolyte disturbances and acidosis during periods of myocardial ischaemia. This study aimed to compare the efficacy and safety between the histidine-tryptophan-ketoglutarate (HTK) solution and blood cardioplegia in various cardiac surgeries. Three-hundred-twenty patients aged 30-70 years old undergoing various cardiac surgeries were randomized into the HTK group and the blood cardioplegia group. The ventilation time, total bypass time, cross-clamp time, length of intensive care unit (ICU) or hospital stay, and postoperative complications were analyzed. The total bypass time and cross-clamp time were significantly shorter in the HTK group than in the blood cardioplegia group (P < 0.001). Segmental wall motion abnormalities (SWMA) at postoperative echocardiography were significantly higher in in the blood cardioplegia group (P = 0.008). The number of patients requiring DC Shock was significantly higher in the HTK group (P < 0.001). The number of patients requiring inotropic support was significantly higher in the blood cardioplegia group (P < 0.001). The length of ICU, hospital stay, and ventilation time were significantly longer in the blood cardioplegia group than in the HTK group (P = 0.004, P < 0.001, P < 0.001, respectively). The number of patients requiring prolonged ventilation was significantly higher in the blood cardioplegia group compared with the HTK group (P = 0.022). There was no significant difference between the study groups regarding electrocardiographic changes, 30-day mortality, and 30-day readmission. The use of HTK cardioplegia was associated with significantly shorter cross-clamp time, bypass time, duration of mechanical ventilation, length of ICU stay, and length of hospital stay. It is associated with less incidence of postoperative segmental wall abnormalities and less need for inotropic support than blood cardioplegia. Custodiol cardioplegia is a safe and feasible option that can be used as an effective substitute for blood cardioplegia to enhance myocardial protection.

Impact of avoiding cardioplegic arrest on clinical outcome in patients undergoing CABG in Bangladesh: a systematic review and meta-analysis.

Over the last decade, the practice of surgical revascularization for the coronary artery disease has been popularized in Bangladesh. Our aim was to compare the outcome of non-cardioplegic versus cardioplegic coronary artery bypass surgery in terms of early postoperative outcomes. A literature search was conducted in March 2020 on Medline (via PubMed), Scopus and Bangladesh Journal Online electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All randomized controlled trials and observational studies reporting findings of coronary revascularization surgery comparing the outcomes were included. Fifteen studies were used quantitatively that included a total cohort of 4750 coronary artery bypass graft (CABG) patients in Bangladesh. After the meta-analysis, we observed a longer duration of operating time [mean difference (MD): - 52.30, confidence interval (CI): - 67.73 to - 36.86, I 2 18 = 89%, p < 0.00001] and a higher incidence of postoperative atrial fibrillation [risk ratio (RR): 0.43, CI: 0.14 to 0.80, I 2 = 44%, p = 0.01] in the cardioplegic CABG group as compared with the non-cardioplegic group. Additionally, statistically significant longer duration of ventilation time (MD: - 8.64, CI: - 9.47 to - 7.82, I 2 = 82%, p < 0.00001) and ICU stay (MD: - 17.25, CI: - 33.36 to - 1.14, I 2 = 99%, p = 0.04) was observed in the cardioplegic group. No significant differences in number of grafts and in-hospital mortality were found between the two groups. Non-cardioplegic CABG may be a viable alternative to cardioplegic CABG in Bangladeshi population, providing similar postoperative outcomes but offering additional advantage of shorter operation and ventilation times.

Blood mRNA Expression Profiles of Autophagy, Apoptosis, and Hypoxia Markers on Blood Cardioplegia and Custodiol Cardioplegia Groups.

Introduction:Blood cardioplegia (BC) and Custodiol cardioplegia (CC) have been used for a long time in open heart surgery and are highly effective solutions. The most controversial issue among these two is whether there is any difference between them regarding myocardial damage after ischemia surgery. In this study, autophagy, apoptosis, and hypoxia markers were investigated and that way we evaluated the differences between BC and CC patients.Methods:A total of 30 patients were included in this study, using two different cardioplegic solutions. Three different whole blood samples of the patients were taken from a central vein (preoperatively, immediately postoperatively, and one day after surgery). Total ribonucleic acid was extracted from these samples. Quantitative real-time polymerase chain reaction was performed, and changes in gene expression were determined by the 2-∆∆Ct method of relative quantification.Results:In the CC group, Beclin gene expression level was found to be higher and this difference was statistically significant (P=0.0024). Similarly, cysteine-aspartic acid protease (caspase) 9 and hypoxia-inducible factor 1α messenger ribonucleic acid (mRNA) gene expression level increased and were significantly different in the CC group. In the BC group, Beclin and microtubule-associated protein light chain 3 expressions were higher in the samples taken one day after surgery. Caspases 3 and 8 gene expressions were significantly different in the BC group.Conclusion:As a result of the analysis performed between the two cardioplegia groups, it has been shown that CC harms the myocardium more than BC at the level of mRNA expression of related markers.

The effect of cold crystalloid versus warm blood cardioplegia on the myocardium during coronary artery bypass grafting

Background: The optimal cardioplegic solution is still debated. The objective of this study was to compare the effect of cold crystalloid versus warm blood cardioplegia on the myocardial injury during coronary artery bypass grafting.&#x0D; Methods: The study included 34 consecutive patients who underwent elective primary on-pump isolated coronary artery bypass grafting from 2016 to 2019. We randomly assigned the patients into two groups. Group (ICCC) (n= 17) received intermittent antegrade cold crystalloid cardioplegia and Group (IWBC) (n= 17) received intermittent antegrade warm blood cardioplegia.&#x0D; Results: There was no difference in the preoperative and operative variables between groups. The time taken by the heart to regain normal sinus rhythm was significantly longer in the cold crystalloid group (7.06 ± 1.8 vs. 2.17 ± 0.8 minutes, p&lt;0.001) with a higher rate of reperfusion ventricular arrhythmia (35% versus 6%; p=0.03) compared to the warm blood cardioplegia group. Both coronary sinus acid production and lactate level were significantly higher in the warm blood group than in the cold crystalloid group (p&lt; 0.001 and 0.043, respectively). The ischemic ECG changes and the severity of new segmental wall motion abnormalities were non-significantly different between both groups (p= 0.68 and 0.67, respectively). Postoperative CK-MB and cTnI levels in all-time points were not significantly different between groups (p= 0.46 and 0.37, respectively). ICU (2.29 ± 0.77 vs. 2.41 ± 0.87 days, p= 0.68) and hospital stay (9.28 ± 0.76 vs. 9.42 ± 0.88 days, p= 0.62) were non-significantly different between both groups.&#x0D; Conclusion: Intermittent antegrade cold crystalloid cardioplegia was associated with attenuated myocardial metabolism. However, it was associated with a longer time to regain normal sinus rhythm and more reperfusion ventricular arrhythmias. We did not find differences in the clinical and echocardiographic outcomes and cardiac enzymes between cold crystalloid and warm blood cardioplegia.

Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusion

ObjectivesAn incomplete restoration of left ventricular contractility after del Nido cardioplegia was noted in our recent study. This study tested the hypothesis that terminal warm blood cardioplegia promotes a prompt restoration of left ventricular performance after a prolonged single-dose del Nido cardioplegia. MethodsFourteen piglets were subjected to 120 minutes of arrest by del Nido cardioplegia without terminal warm blood cardioplegia (del Nido cardioplegia group; n = 7) or with terminal warm blood cardioplegia before reperfusion (terminal warm blood cardioplegia group; n = 7). The other 7 piglets underwent total cardiopulmonary bypass without ischemia/reperfusion for 150 minutes (control group). Left ventricular function was assessed by percent recovery of end-systolic elastance as the contractility and percent end-diastolic pressure–volume relationship as the compliance using a conductance catheter. Troponin T and the mitochondrial score were also measured. ResultsDepressed percent recovery of end-systolic elastance was sustained in the del Nido cardioplegia group, and a prompt restoration of end-systolic elastance was achieved using terminal warm blood cardioplegia (57.9 ± 17.8 vs 94.7 ± 13.1, P < .028). Percent end-diastolic pressure–volume relationship at the early phase was better in the terminal warm blood cardioplegia compared with the del Nido group (88.5 ± 24.0 vs 101.4 ± 16.8, P = .050). Troponin T was higher in the terminal warm blood cardioplegia compared with the control group (0.80% ± 0.21% and 1.49% ± 0.31%, respectively, P = .002). The mitochondrial score was equivalent in all groups. Spontaneous restoration to sinus rhythm was more frequent in the terminal warm blood cardioplegia group than in the del Nido cardioplegia group (6/7 vs 1/7, P < .028). ConclusionsThe supplementary use of terminal warm blood cardioplegia achieved prolongation of the safe ischemic time up to 120 minutes for a single-dose application.

Custodiol (Histidine-Tryptophan-Ketoglutarate) versus Modified St. Thomas Cold Crystalloid Cardioplegia: Short-term Results

Abstract Background: Myocardial protection refers to strategies used to avoid post-ischemic myocardial dysfunction. One dose approach for myocardial safety is attractive in long operations. Purpose: to assess differences among the custodial cardioplegia and the cold crystalloid cardioplegia according to myocardial protection in cases listed for Double Valve Replacement Surgery. Patient and methods: This prospective cohort trial included 50 cases had double valve replacement surgery between August 2017 and July 2019. Twenty-nine patients were males (58%), and the mean age was 57.66±8.81 years. The mean ejection fraction was 41.43±9.25 %. Results: The mean CPB time in custodial group was 99.4±8.46 while in cold crystalloid cardioplegia group was 95.6±12.27 minutes. The mean DC shocks that was required in custodial group was 9(36%) while in cold crystalloid cardioplegia group was 17 (68%) times. Mean days of ICU stay in custodial group were 1.28±0.46 while in cold crystalloid cardioplegia group were 1.72±0.61 days. The mean duration of mechanical ventilation in custodial group was 4.64±0.86 while in cold crystalloid cardioplegia group was 7.04±0.84 hours. Troponin elevation mean in the immediate post-operative: in custodiol group was 8.46±2.21 while in the cold crystalloid group was 10.08±2.18. Conclusion: This study showed that the evidence supporting the superiority of custodial over cold crystalloid cardioplegia are limited however, Custodiol cardioplegia is appealing as it gives lengthy myocardial protection with a single-dose. The present work demonstrated that Histidine-Tryptophan-Ketoglutarate cardioplegia is related with less ICU stay, mechanical ventilation, postoperative hospitalization and troponin T release in low-risk patients who had double valve replacement.

WARM VERSUS COLD INTERMITTENT BLOOD CARDIOPLEGIA FOR MYOCARDIAL PROTECTION DURING ON-PUMP CORONARY ARTERY BYPASS GRAFTING

Background: Obtaining an optimal surgical result depends on performing a technically proficient operation while protecting the heart from potential damage. Cardioplegia is an essential component in myocardial protection during aortic cross-clamping and cardiopulmonary bypass. The development of cardioplegia solutions is one of the major advances in cardiac surgery that allowed surgeons to extend the period of ischemic arrest to well over 3 hours to perform complex surgical procedures without adversely affecting myocardial functio).Aim of the work: We sought to compare between two specific modalities of myocardial protection using either intermittent ante-grade cold blood cardioplegia or warm blood cardioplegia.Patients and Methods: This prospective study included 200 successive adult patients who have undergone elective on-pump coronary artery bypass grafting (CABG) operations. Randomization was done immediately before the beginning of the operation so that group allocation was blinded to the patient. Participants were recruited between 14 January 2017 and 10 July 2019 at Mahalla Cardiac Center. All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively.Results: There was no statistically significant difference between the two groups as regards bypass and cross clamp times. However, there was a statistically significant difference between the two groups as regards spontaneous defibrillation. There were no significant differences in both groups regarding the needed either inotropic support, or an IABP to achieve weaning. The total period of mechanical ventilation was statistically shorter in the warm group compared to the cold group.Conclusion: We found that there was no difference in the clinical effect of warm or cold blood cardioplegia despite the relative increase in postoperative serum cTnI in the warm cardioplegia group. Both strategies appear to allow a comparable and satisfactory method for myocardial protection during the period of cardiac arrest.

Use of del Nido cardioplegia in acute aortic dissection surgery.

Del Nido cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes. Single-dose del Nido cardioplegia solution may offer an alternative myocardial protection strategy to conventional whole blood cardioplegia following acute aortic dissection surgery. We retrospectively reviewed 122 consecutive patients with acute aortic dissection undergoing arch reconstruction surgery procedure with cardioplegia arrest from January 2017 to December 2019. Patients exclusively received with whole blood cardioplegia (n = 60, January 2017-December 2018) or del Nido cardioplegia (n = 62, January 2018-December 2019). Preoperative and postoperative data were retrospectively reviewed. No significant difference between two groups in mortality (4/60 vs 3/62, p = 0.964), cardiopulmonary bypass time (168.0 ± 10.5 minute vs 165.0 ± 12.5 minute, p = 0.154), aortic cross-clamp time (91.8 ± 9.0 minute vs 93.2 ± 9.5 minute, p = 0.405), selective antegrade cerebral perfusion time (21.8 ± 5.0 minute vs 22.4 ± 4.7 minute, p = 0.496) and postoperative vasoactive inotropic score (34.8 ± 1.9 vs 35.2 ± 2.1, p = 0.272), neurological complications rate (8/60 vs 12/62, p = 0.523), renal insufficiency rate (5/60 vs 7/62, p = 0.807) and the troponin T level (304.8 ± 111.3 vs 315.0 ± 94.9, p = 0.588), respectively. Mean volume of crystalloid was significantly higher in the del Nido group compared to the whole blood cardioplegia group (1010.2 ± 20.3 mL vs 300.0 ± 19.6 mL, p < 0.001). Patients requiring defibrillation was 7/62 vs 28/60 (p < 0.001), with statistical difference in both groups. Short-term outcomes in acute aortic dissection surgery using del Nido cardioplegia solution were acceptable and comparable to conventional multi-dose whole blood cardioplegia. Del Nido cardioplegia technique is associated with lower defibrillations rate and requires a reduced frequency of infusions that results in longer durations between infusions and may be a feasible alternative to conventional whole blood cardioplegia solution in acute aortic dissection surgery.

Antegrade Intermittent Cold Cardioplegia in Comparison to Antegrade Intermittent Warm Cardioplegia in Heart Valve Surgery

Background: The cardioplegic arrest is essential for motionless and bloodless heart valve surgery. The objective of this work was to compare antegrade cold versus warm blood cardioplegia during valve surgery.&#x0D; Methods: This randomized controlled study included 100 patients who had mitral valve surgery. Patients were randomly assigned into two groups; the warm cardioplegic group (n= 50) and the cold cardioplegic group (n= 50). Study endpoints were creatine kinase myocardial band, lactate dehydrogenase, and troponin levels.&#x0D; Results: There was no significant difference in age and sex between groups (p= 0.51 and 0.56, respectively). Cardiopulmonary bypass was significantly longer in the cold group (85.66 ± 22.9 vs. 72.34 ± 25.09 minutes; P= 0.01); however, there was no difference in ischemic time (p= 0.32). The number of DC shocks given for each patient is less in the warm group with a median of 1.5 (range 1-3 times), while in the cold group, the median was 2 (range 2-4 times); p= 0.02. The amount of blood loss was significantly lower among the warm group (645.4 ± 464.93 ml vs. 404 ± 252.7 P&lt; 0.01). warm group had significantly lower postoperative CK (532.78 ± 249.08 vs. 638.14 ± 344.01 IU/L; P&lt; 0.01), CK-MB (78.64 ± 34.58 vs. 103.18 ± 82.11; P&lt; 0.0.01), LDH level (805.3 ± 322.71 vs. 1060.88 ± 500.94 mg/dl; P&lt; 0.01) and (0.4148 ± 0.226 vs. 0.6404 ± 0.411 ng/ml; P&lt; 0.01). &#x0D; Conclusion: Antegrade warm blood cardioplegia may provide better myocardial protection during valve surgery compared to the cold cardioplegia. A larger study is recommended.

Early Administration of Crystalloid Cardioplegia after Circulatory Death in a Porcine Model of Cardiac Resuscitation

Transplantation of hearts donated after circulatory death (DCD) remains challenging due to the risk myocardial injuries. These hearts are exposed to hypoxia and prolonged warm ischemic time (WIT). We hypothesize that administration of cardioplegia (CPG) after extended WIT could make DCD hearts suitable for transplantation without severe myocardial injury. A hypoxic cardiac arrest was induced in twelve piglets (40 kg). Since peripheral cannulation could not be considered, a normothermic regional perfusion (NRP) was established between the right atrium and the aortic arch, 5 min. after mechanical asystole. In the CPG group (n=6), a crystalloid solution (40 mL/kg, Celsior, IGL, Lyon, France) was administered after 15 min. of WIT, while no preservation solution was administrated in the control group (n=6). The aortic clamp was released after 35 min. and NRP withdrawal was attempted 60 min. after cardiac reperfusion. Pressure-volume loops were performed before and after cardiac resuscitation. Early ischemic changes were detected on Masson's trichrome staining and incorporated to a composite score. Agonal phase was 14 min. in the CPG group (9.5-14) vs. 12 min. (11-13) (P=1.0). Three (50%) piglets could be weaned from NRP in the CPG group, vs. 1 (16.7%) in the CTL group (P=0.55). Troponin I was not different between groups (53 vs. 49 µg/L, P=0.73). All resuscitated hearts had biventricular function impairment with marked decline in left ventricular end-systolic elastance. Left ventricular ischemic changes were less severe in CPG group (P=0.034), while multifocal myocardial injury of the right ventricle was observed in both groups (Figure 1). Early administration of crystalloid cardioplegia was associated with a 50% rate of heart resuscitation in our porcine model. The viability of DCD hearts after prolonged WIT was limited by right ventricular severe injury.

Safety of del Nido cardioplegia in coronary artery bypass grafting combined with heart valve replacement in adults

Objective: To investigate the safety and myocardial protective effect of del Nido cardioplegia in coronary artery bypass grafting combined with heart valve replacement in adults. Methods: From April 2018 to April 2019, 84 patients undergoing coronary artery bypass grafting combined with heart valve replacement under cardiopulmonary bypass (CPB) in the Second Affiliated Hospital of Nantong University and Shanghai Chest Hospital were selected, and divided into del Nido cardioplegia (n=44) group and Thomas cardioplegia (n=40) group using a random number table. The concentration of troponin was measured before anesthesia induction and 2, 12 and 24 hours after the termination of CPB, respectively. Results: The preoperative characteristics of each group were similar, including age, underlying diseases, and body surface area (all P>0.05). The frequency of intraoperative cardioplegia infusion in the del Nido group was significantly lower than that in the Thomas group (P=0.03). Compared with the del Nido group, troponin concentration in the Thomas group increased significantly at 12 hours [(4.59±0.76) μg/L vs (2.20±0.53) μg/L, t=-16.653, P<0.001] and 24 hours [(6.70±0.97) μg/L vs (1.96±0.58) μg/L, t=-26.975, P<0.001] after CPB. No statistically significant differences were found in the postoperative recovery of cardiac autonomic rhythm (P=0.887), cardiac defibrillation (P=0.880), positive inotropic drugs (P=0.163) and left ventricular ejection fraction (P=0.338) between the two groups. Conclusions: It is safe to use del Nido cardioplegia in coronary artery bypass grafting combined with heart valve replacement in adults, which can reduce the frequency of cardioplegia infusion and simplify the surgical procedure. The trend of troponin concentration suggests that del Nido cardioplegia has a better myocardial protective effect.

Abstract 330: Intra-Arrest Cardioplegia Prevents the Diastolic Dysfunction Induced by Prolonged VF Arrest

Introduction: There are approximately 400,000 out-of-hospital cardiac arrests annually, including one-third with VT/VF as their initial rhythm. Approximately 60% of VF arrests are refractory to initial resuscitation requiring prolonged CPR and transport to an ECPR center where available. Limiting myocardial injury during this time is critical as it contributes CPR efficiency. The aim of this study was to investigate the effect of cardioplegia on preservation of cardiac function during cardiac arrest. Hypothesis: Following induction of VF, the administration of potassium-based cardioplegia will reduce energy utilization and prevent diastolic dysfunction with preservation of contractility following washout of cardioplegia. Methods: Hearts were isolated from male Brown Norway rats (n=8) and prepared on a Langendorff apparatus in Krebs solution. Left ventricular pressure was measured throughout the study. Hemodynamics were obtained for 15 min prior to 2 min of rapid pacing to induce VF. After 10 min of VF, cardioplegia was induced with a bolus of 160 μeq potassium. After 10 min, the potassium was washed out and the hearts were reperfused with Krebs-Henseleit solution. Hemodynamics were measured for another 60 min. Results: Baseline hemodynamics were similar between the control and cardioplegia groups. Cardioplegic hearts had significantly lower left heart pressures at the end of the VF time compared to control hearts (24 vs. 74 mmHg, p&lt;0.05). Following 60 min of reperfusion and cardioplegia washout, diastolic pressures remained lower in hearts receiving cardioplegia (39 vs 10 mmHg, p&lt;0.05). After 60 min of reperfusion, systolic pressures were the same among the groups, and while rate of contraction and relaxation were numerically faster in hearts receiving cardioplegia, these differences were not significant. Conclusions: Potassium cardioplegia, given during ongoing VF arrest, was effective at preventing diastolic dysfunction caused by prolonged ischemia. Washout of the cardioplegia at the time of reperfusion allowed for ROSC and preserved left ventricular relaxation. These studies suggest that the use of cardioplegia in refractory VT/VF arrest may be beneficial in reducing myocardial damage and preserving function during prolonged CPR.

Myocardial protection in the arterial switch operation: Custodiol versus cold blood cardioplegia.

The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.

Comparison of Custodiol vs warm blood cardioplegia and conditioning of donor hearts during transportation with the organ care system.

ObjectivesCold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS.MethodsWe performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution ( n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated.ResultsAll donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)‐6 and IL‐8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients.ConclusionsThe use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.

Intermittent Cross-Clamp Fibrillation Versus Cardioplegic Arrest During Coronary Surgery in 6,680 Patients: A Contemporary Review of an Historical Technique

Myocardial management during on-pump coronary artery bypass grafting (CABG) surgery includes aortic cross-clamping followed by fibrillation (XCF) and aortic cross-clamping followed by diastolic cardioplegia (cardioplegia). The authors wished to compare in-hospital and survival outcomes between these procedures. A retrospective observational study utilizing propensity matching. Tertiary Referral Centre for Heart Surgery. A total of 8,875 consecutive patients undergoing CABG surgery between August 1999 and February 2018. After 1:1 matching, the authors had 3,340 patients in the cardioplegia group and 3,340 in the XCF group. Baseline characteristics were not significant between the matched cardioplegia and XCF groups. The XCF group had shorter pump times (61.8 minutes +/-26.8 v 74.7 minutes +/-29.5, p < 0.0001) and shorter cross-clamp times (27.80 minutes +/-10.5 v 44.44 minutes +/-18.0, p < 0.0001) compared with the cardioplegia group despite a similar median number of distal anastomoses (3 v 3, p = 0.08). After surgery, atrial arrhythmias (32% v 36%, p = 0.01) and inotropic requirement (25% v 28%, p = 0.006) were less in the XCF group compared with the cardioplegia group, respectively. Other postoperative outcomes (such as mortality and cerebrovascular events) were not statistically different. There was a mean survival advantage in using cardioplegia compared with XCF (15.4 years versus 14.7 years, log-rank, p = 0.014; 10-year survival 64% v 61% and 18-year survival 38% v 34%). This is the largest analysis of XCF. XCF does not adversely affect in-hospital outcomes. Long-term results demonstrate cardioplegic arrest may convey a survival advantage that would preclude routine XCF in the modern era.