Method Of Myocardial Protection Research Articles

Uncommon presentation of acute type A aortic dissection: sleeve-severed and everted proximal right coronary artery intima without myocardial ischaemia

BackgroundType A aortic dissection (TAAD) with coronary involvement is rare but potentially fatal. Proper myocardial protection during surgery is essential.Case presentationHere, we describe a 52-year-old woman who presented with sudden chest pain. CT angiography revealed TAAD with right coronary artery involvement. During surgery, the proximal intima of the right coronary artery was found to be completely severed and everted. Conventional myocardial perfusion methods were inadequate. A patented perfusion tip for coronary artery orifice perfusion was used, resulting in favourable surgical outcomes. The patient was discharged without complications.ConclusionsThis case emphasizes the need for careful preoperative assessment of coronary involvement in TAAD patients. The myocardial protection method used here is very helpful and can be applied effectively in similar cases encountered by surgeons.

Clinical anatomy of the coronary venous system and relevance to retrograde cardioplegia and cardiac electrophysiological interventions.

Anomalies of coronary venous system, the valve of the coronary sinus (Thebesian valve) and other cardiac malformations may make interventions through the coronary sinus difficult. These variants may pose a challenge in cannulating the coronary sinus for retrograde cardioplegia and for interventions performed through the coronary sinus by cardiac electrophysiologist/interventional cardiologist. Retrograde cardioplegia is an established method of myocardial protection with advantages, indications, and complications. A good knowledge of the anatomy of the coronary sinus and its variants is important in understanding the difficulties encountered while cannulating the coronary sinus for the delivery of retrograde cardioplegia, cardiac resynchronization therapy, treatment of arrhythmias, and percutaneous mitral valve annuloplasty.

Comparison of Bretschneider HTK cardioplegia solution and blood cardioplegia in terms of postoperative results in patients who underwent isolated supracoronary ascending aortic replacement.

Cardiac arrest with cardioplegia is the most common and reliable method of myocardial protection in cardiac surgery, but there is no definite consensus on the use of different types of cardioplegia. Two of the commonly used types of cardioplegia are Bretschneider histidine-tryptophan-ketoglutarate solution (Custodiol) and conventional blood cardioplegia. In this study, Custodiol solution and conventional blood cardioplegia used in patients with type A aortic dissection who underwent supracoronary ascending aortic replacement were aimed to be compared in terms of postoperative results. 70 patients with type A aortic dissection who underwent supracoronary ascending aortic replacement in our clinic between January 2011 - October 2020 were included. Patients were divided into two groups, blood cardioplegia group (n = 48) and Custodiol group (n = 22) and they were compared regarding preoperative, perioperative and postoperative variables. There was no significant difference between cardiopulmonary bypass time and cross-clamp time (p = 0.17 and p = 0.16, respectively). Mechanical ventilator weaning time, intensive care unit stay and hospital stay were shorter in Custodiol group (p = 0.04,p = 0.03 and p = 0.05, respectively). While inotropic support need was higher in the blood cardioplegia group (p = 0.001), there was no significant difference in terms of mortality, arrhythmia, neurological complications and renal complications. Our results show that Custodiol cardioplegia solution may be superior to blood cardioplegia in reducing mechanical ventilation weaning period, intensive care and hospital stay, and reducing the use of inotropic agents in patients with type A aortic dissection undergoing supracoronary ascending aorta replacement.

Электрокардиографические изменения в раннем периоде после плановой реваскуляризации миокарда

INTRODUCTION: To date, highly effective methods of myocardial protection have been developed, which are widely used in cardiac surgery. At the same time, the problem of perioperative myocardial infarction still exists and is one of the causes of adverse cardiovascular events and mortality, both at the hospital stage of treatment and in the long-term period. A factor leading to such a complication may be acute dysfunction of the coronary bypass graft, the timely detection and elimination of which will reduce the negative consequences of myocardial damage. The relevance of the study results from investigation of the relationship between the angiographic data and the character of ischemic changes on the electrocardiogram of patients with and without proven acute dysfunction of coronary bypass graft. AIM: Identification of the most pathognomonic electrocardiographic signs of dysfunction of coronary bypass grafts in the early postoperative period after planned myocardial revascularization. MATERIALS AND METHODS: The study included 196 (1.86%) of 10,550 patients operated for coronary artery disease in Chelyabinsk Center of Cardiovascular Surgery from 2011 to 2020, who underwent emergency angiography after planned coronary artery bypass graft surgery due to the appearance of signs of myocardial damage in the early postoperative period. Depending on the type of angiographic findings and the chosen treatment tactics, patients were divided to 3 groups. Group I (n = 86) included patients in whom angiography revealed defects in the area of large bypassed coronary arteries, of them 60 patients underwent endovascular treatment, and 26 patients underwent repeated open surgery. Group II (n = 33) consisted of patients in whom bypass graft dysfunction was noted, but, however, due to the small diameter or pronounced diffuse lesion of the bypassed coronary arteries, all the patients underwent conservative therapy. Group III included 77 patients in whom hemodynamically significant defects in grafts and native arteries were not identified. RESULTS: When studying postoperative electrocardiographic data, it was found that significant differences between the groups were obtained only in the occurrence of ventricular arrhythmias (P1–2 = 0.027; P2–3 = 0.01). As for other pathological electrocardiographic signs and their combinations, no statistical differences were found. CONCLUSIONS: An isolated electrocardiographic study in the early postoperative period does not permit to identify patients with dysfunction of coronary bypass grafts. It is necessary to develop a diagnostic algorithm, including instrumental and laboratory methods, for accurate diagnosis of myocardial ischemia caused by impaired graft function or pathological deformation of the coronary bed due to surgical procedures.

ЧАСТОТА, ФАКТОРЫ РИСКА И ПРЕДИКТОРЫ РАЗВИТИЯ СИНДРОМА МАЛОГО СЕРДЕЧНОГО ВЫБРОСА ПОСЛЕ ОПЕРАЦИЙ НА ОТКРЫТОМ СЕРДЦЕ

Purpose. To study the incidence and to determine predictors of postcardiotomy low cardiac output syndrome after open-heart surgery. Methods. A retrospective, observational case-control study was conducted at the Republican Scientific and Practical Center of Cardiology for the period 2015–2017. The study included 1, 540 patients who underwent open-heart surgery. Intraoperatively and in early postoperative period, 46 patients developed postcardiotomy low cardiac output syndrome (PCLCOS) refractory to drug therapy, followed by mechanical circulatory support (the study group), the comparison group consisted of 1, 494 patients. Results. The incidence of PCLCOS was 2.98%. The predictors of PCLCOS included the following: reoperation OR = 3.65 (95% CI 1.40–9.51), myocardial infarction (30 days) before operation OR = 7.20 (95% CI 2.25–23.01), heart failure NYHA class III/IV OR = 2.38 (95% CI 1.30–4.37), and preoperative local contractility index more than 1.81, OR = 2.92 (95% CI 1.50–5.68). Conclusion. Postcardiotomy low cardiac output syndrome is still a big issue in cardiac surgery. Despite modern methods of myocardial protection and mechanical circulatory support (MCS), hospital mortality remains extremely high, up to 80%. Prognosis based on predictive mo-dels will allow timely selection of the required type of MCS, reducing the incidence of multiple organ failure, and, as a result, adverse outcomes of surgical treatment.

Anesthetic management of primary cardiac tumor in the coronary sinus and right atrium

The patient presented with complete atrioventricular block and dyspnea. They had a primary cardiac tumor originating in the coronary sinus, a rare site of origin. It filled the sinus and involved the right atrium. The patient might have presented with complete atrioventricular block due to tumor invasion and respiratory distress due to elevated LVEDP as the tumor filled the coronary sinus. As for anesthesia management, in addition to the usual management, we observed CS obstruction and also considered myocardial protection methods. It is important to anticipate the risks and develop an appropriate anesthetic plan accordingly.

Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice

Myocardial infarction (MI) is a cardiovascular disease with high morbidity and mortality. Clinically, rehabilitation after massive MI often has a poor prognosis. Therefore, it is necessary to explore the therapeutic methods of myocardial protection after MI. As a first-line treatment for type 2 diabetes, metformin has been found to have a certain protective effect on myocardial tissue. However, its pharmacological mechanism remains unclear. In this study, we investigated key factors that reduced MI with metformin. Through in vivo, in vitro, and in silico analyses, we identified HSF1 as a key target for metformin. HSF1 could up-regulate the transcriptional level of AMPKα2 through transcriptional activation and stimulate the activity of the downstream AMPK/mTOR signaling pathway. Metformin stimulated cardiomyocytes to form stress granules (SGs), and knockdown of HSF1 reversed this process. Furthermore, HSF1 exhibited better in vitro affinity for metformin than AMPK, suggesting that HSF1 may be a more sensitive target for metformin.

Comparison between Bretschneider -HTK solution and antegrade cold blood cardioplegia as a method for myocardial protection in thoracic aortic surgery

Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myocardial protection due to the increasing complexity of cardiac surgical procedures, especially thoracic aortic operations which require extended myocardial ischemic periods. The goal of this study was to assess the safety and efficacy of cold crystalloid single dosage Histidine Tryptophan Ketogultarate (Custodiol) cardioplegia to cold blood multidose cardioplegia in aortic surgery patients. Methods: Our study included 100 elective and emergency aortic surgery patients. Fifty patients received Custodiol cardioplegic solution (group A) and fifty received cold blood cardioplegia (group B). We evaluated post-operative cardiac Troponin I release, postoperative morbidities and mortality. Results: Troponin I peak release, duration of inotropic support & intensive care unit stay were more in the cold blood group. Hemofiltration and intraoperative requirement of blood products transfusion were more in the Custodiol group. No differences were found regarding cross-clamp time, arrhythmias, postoperative ejection fraction and in-hospital mortality. Conclusion: In patients having thoracic aortic surgery, custodiol and cold blood cardioplegic treatments give good myocardial protection. Custodiol usage was linked to lower troponin levels, shorter inotropic support periods, and shorter ICU stays. In terms of early mortality and morbidity, there was no statistically significant difference between the two groups.

Use of del Nido cardioplegia in adult cardiac surgery

In most adult cardiac surgery operations, the heart must be completely immobile and isolated from the blood. Therefore, the heart is stopped in diastole and a still operative site is obtained. Cardiac arrest results in ischemia-reperfusion injury. For these reasons, myocardial protection and the prevention of damages are required. Various cardioplegia solutions are used for this purpose. It can be said that cardioplegia is the gold standard method of myocardial protection in cardiac arrest. Nowadays, "Single-dose cardioplegia" applications are increasingly used, especially in minimally invasive cardiac surgery and basic coronary bypass procedures due to the advantages they provide, which include reduction of aortic cross-clamp time, prevention of frequent interruption of the procedure due to cardioplegia, and reduced postoperative myocardial dysfunction incidence. The two main solutions used in single dose cardioplegia applications are the Bretschneider solution and the del Nido extracellular cardioplegia solution. The del Nido cardioplegia solution (dNCS), which was originally developed for use in pediatric cardiac surgery, has recently increased its use in adult cardiac surgery due to straightforward application and long-term effectiveness. The del Nido cardioplegia reduces the aortic cross clamp duration, cardiopulmonary bypass time and required cardioplegia solution volume, and is a safer and superior cardioplegia solution and technique in terms of myocardial protection with regards to many organs and cardiac-biochemical parameters.

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

Single-Dose Cold Modified Bretschneider Solution for Myocardial Protection in the Surgical Treatment of Patients with Aortic Valve Stenosis and Left Ventricular Hypertrophy

Summary Aortic valve stenosis (AS) is predominantly caused by degenerative calcification in patients over 70 years. It obstructs the left ventricular outflow tract. The result is concentric left ventricular hypertrophy (LVH) wall stress and ischemia-induced myocardial fibrosis. [1] According to the European Association of Cardiothoracic Surgery, all high-grade AS patients are indicated for Aortic valve intervention [2]. One of the most recommendable methods for myocardial protection during surgical aortic valve replacement is antegrade delivery of cold crystalloid cardioplegia. Our retrospective study included 173 operated patients with AS and LVH. We observed the MB fraction of the enzyme creatine phosphokinase (CPK-MB) as a postoperative marker for myocardial hypoprotection in different patients. Our results showed that a single dose of modified Bretschnaider solution provided safe and long enough myocardial protection during conventional and minimally invasive aortic valve replacement in patients with AS and LVH [3].

COMPLETE REPAIR OF TETRALOGY OF FALLOT (TOF) ON BEATING HEART SURGERY WITHOUT AORTIC CROSS CLAMPING : REPORT OF A CASE

Introduction: Reperfusion injury is a well-known phenomenon that occurred in cardioplegic techniques with cardiopulmonary bypass. Therefore great effort is made to prevent reperfusion injury. Beating Heart Continuous Coronary Perfusion (BHCCP) surgery is one of the alternative techniques to improve an ischemic reperfusion injury in open-heart surgery, either in pediatric or in adult. This technique can be done in complete repair of tetralogy of Fallot (TOF). Purpose: To report our first experience in doing complete repair of TOF using beating heart technique without aortic cross-clamping Case Report: A five-year-old boy came on to ER on January 6th, 2012, with a history of cyanotic since birth. His echocardiography and catheterization concluded a tetralogy of Fallot with a McGoon ratio of 1.95 (the diameter of RPA and LPA were 9.14 mm and 8.79 mm, respectively). A complete repair of TOF was done using beating heart surgery without aortic cross-clamping technique. One month post-surgery evaluation, there weren't any neurological or motor disorders. Echocardiography results showed no residual pulmonary stenosis, but 0.2 mm residual VSD was found. Conclusion: This heart rate technique is an alternative method of myocardial protection in cardiac surgery. In several cardiac centres globally, this technique is relatively safe and can be used during surgery, especially in the total correction of TOF.

Initial experience with del Nido cardioplegia solution at a Pediatric and Congenital Cardiac Surgery Program in Brazil.

The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients. Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas' solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality. Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance. In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas' solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.

Experience in the Use of Artificial Fibrillation in the Correction of Postinfarction Left Ventricular Aneurysms as the Most Appropriate Alternative to Pharmaco-Cold Protection of the Heart

Coronary heart disease (CHD) is the leading cause of death in the world. In most cases, the disease is complicated by myocardial infarction (MI) followed by the formation of a left ventricular aneurysm (LVA), ruptures of the interventricular septum, ischemic cardiomyopathy, mitral regurgitation and arrhythmias. Postinfarction left ventricu-lar aneurysm is the most common and severe complication of CHD. There are a lot of methods of LVA surgical correc-tion, including Cooley’s linear repair technique, purse-string technique of Jatene and endoventriculoplasty using the Dor technique. Over the last year, 43 left ventricular aneurysm repair surgeries were carried out at the NatioМешковаnal M. M. Amosov Institute of Cardiovascular Surgery. Depending on the comorbidities, age, left ventricular contractility and other factors, plastic correction was performed using artificial fibrillation (n = 24 [55.8%]) or cardioplegic solution (n = 19 [44.2%]) for myocardial protection. Significant difference in the mean duration of the operation, the time the patient was on the artificial circulation, the amount of inotropic support, the time of mechanical ventilation, and the contractile function of the left ventricle (LV) was observed. In group 1, where artificial left ventricular fibrillation was used for myocardial protection, the mean duration of the surgery was 1.9 ± 0.2 h shorter. Accordingly, the patient’s stay on the artificial circulation decreased by 92.2 ± 0.3 minutes. Also, the duration of mechanical ventilation was significantly shorter: 4.6 ± 0.8 hours and 7.3 ± 0.7 hours in groups 1 and 2, respectively.
 And most importantly, in the group 1 the ejection fraction increased by 2.3 ± 0.45% compared with 1.17 ± 0.43% in the group 2. However, all the other parameters were similar in both groups. This gives reason to consider artificial ven-tricular fibrillation as the most appropriate method of myocardial protection in the future.

Novel controlled and targeted releasing hydrogen sulfide system exerts combinational cerebral and myocardial protection after cardiac arrest

BackgroundCardiac arrest (CA) is a leading cause of death worldwide. Even after successful cardiopulmonary resuscitation (CPR), the majorities of survivals are companied with permanent myocardial and cerebral injury. Hydrogen sulfide (H2S) has been recognized as a novel gasotransmitter exerting multiple organ protection; however, the lacks of ideal H2S donors which can controlled release H2S to targeted organs such as heart and brain limits its application.ResultsThis work utilized mesoporous iron oxide nanoparticle (MION) as the carriers of diallyl trisulfide (DATS), with polyethylene glycol (PEG) and lactoferrin (LF) modified to MIONs to acquire the prolonged circulation time and brain-targeting effects, and a novel targeted H2S releasing system was constructed (DATS@MION-PEG-LF), which exhibited excellent biocompatibility, controlled-releasing H2S pattern, heart and brain targeting features, and the ability to be non-invasive traced by magnetic resonance imaging. DATS@MION-PEG-LF presented potent protective effects against cerebral and cardiac ischemic injury after CA in both in vitro hypoxia/reoxygenation models and in vivo CA/CPR models, which mainly involves anti-apoptosis, anti-inflammatory and anti-oxidant mechanisms. Accordingly, the cardiac and cerebral functions were obviously improved after CA/CPR, with potentially improved survival.ConclusionsThe present work provides a unique platform for targeted controlled release of H2S based on MIONs, and offers a new method for combinational myocardial and cerebral protection from ischemic injury, bringing considerable benefits for CA patients.

Custodiol versus extracellular crystalloid cardioplegia in mitral valve replacement in patients with low ejection fraction

Background The use of cardioplegia solution is aimed to avoid myocardial muscle damage, leading to poor contraction and abnormal increased release of cardiac biomarkers enzymes during cardiac arrest. It remains the primary method for myocardial protection against ischemia–reperfusion injury during cardiac surgery. Cardioplegia was first presented as an agent for hypothermic hyperkalemic arrest. Blood was then introduced as a vehicle to convey potassium to the heart. Histidine–tryptophan–ketoglutarate solution is safe and used as a single dose that can last for up to 3 h. Comparison between custodiol cardioplegia and cold blood cardioplegia still remains a big debate till now. Objective To compare the clinical outcomes of custodiol solution with cold blood cardioplegia in mitral valve replacement (MVR) with cardiac ejection fraction less than 45%. Patients and methods This single‑center randomized prospective study was carried out from January 2018 till June 2019 at Ain Shams University hospitals. Overall, 65 patients with poor left ventricular function undergoing mitral valve replacement were divided randomly according to type of myocardial protection into two groups: group A included 30 patients who received custodiol cardioplegia, and group B included 35 patients who received cold blood cardioplegia. Data from each group were collected and compared with each other. Results Baseline demographic and intraoperative data showed no significant difference between the two groups. The need for inotropic support, length of mechanical ventilation, and ICU stay were statistically nonsignificant between the two groups. There was a statistically significant difference regarding the rhythm upon declamping [ventricular fibrillation (VF) in 17 (56.7%) cases in group A and nine (25.7%) cases in group B (P=0.016)], and also there was a significant difference in times of defibrillation cardioversion (DC) shock given after declamping (P=0.005). Overall mortality shows a statistically nonsignificant difference. There is a significant difference in postoperative echo assessment for both groups [ejection fraction in group A: 53.17±7.73 compared with 49.06±7.170 in group B (P=0.031)], and there is also a difference in hemoglobin postoperatively, with 10.35±0.843 in group A compared with 10.88±0.798 in group B (P=0.013). Conclusion Cardiac arrest using custodiol cardioplegia is a good choice in mitral valve replacement with the advantage of giving only one dose of cardioplegia without interruption of the operation, and also it gives good postoperative echo results than cold blood cardioplegia. Its disadvantages are lower hemoglobin levels postoperatively and hyponatremia during bypass in comparison with cold blood cardioplegia.

Patients of risk groups in the perioperative period: the review of modern guidelines

Background. According to the Decree of the Ministry of Health of Ukraine № 275 issued on 11.09.2018, there is a list of measures to ensure surgical safety and patient’s safety. These measures can be divided into those that should be performed 1) before anesthesia; 2) before skin dissection; 3) before the patient leaves the operating room. Perioperative medicine (POM) is a patient-centered and interdisciplinary perioperative care for surgical patients.
 Objective. To describe the current recommendations for POM.
 Materials and methods. Review of available guidance documents.
 Results and discussion. The pathophysiology of postoperative complications (infectious processes, intestinal paralysis, respiratory failure, kidney damage, etc.) includes the following factors: triggers (anxiety, pain, surgical trauma), patient factors (age, comorbid conditions), the consequences of general operative stress (autonomous system imbalance, inflammation, coagulopathy, metabolic imbalance). Clinical evaluation or biomarkers should be used to identify high-risk patients in the perioperative period. Measures to improve postoperative rehabilitation should be carried out in the pre-, intra- and postoperative period. Thus, in the preoperative period it is necessary to examine the patient, to provide the carbohydrate load 2 hours before the intervention, to conduct antibiotic prophylaxis, to correct or stabilize the comorbid diseases (especially cardiovascular and renal diseases, diabetes, anemia). In the intraoperative period it is necessary to maintain normovolemia and normothermia, to use protective mechanical lung ventilation, to limit the use of opioids, to perform extubation immediately after the intervention. In the postoperative period early activation, early enteral nutrition and early removal of drainages and catheters should be used. The key components of POM include the identification of low-risk patients in order to save resources, the identification of high-risk patients with the possible use of alternative management strategies, and the frequent risk reassessment. The main components of the success of anesthesia include preoperative assessment of the patient’s somatic status and risk, use of controlled hypnotics and effective and predictable muscle relaxant, use of analgesics that break down quickly and have no ability to accumulate, control of the hemodynamics stability, blood gases and acid-base balance. To prevent the perioperative myocardial ischemia, it is advisable to use esmolol – a cardioselective β-blocker of ultrashort action. Preoperative anxiety, intubation and extubation, surgical manipulations lead to the excessive adrenergic response, which justifies the use of β-blockers. The pharmacological effects of esmolol (Biblok, “Yuria-Pharm”) include the reduction of myocardial oxygen consumption, increase of the diastole duration, limitation of the free radicals’ production, control of the activity of metalloproteinases, and the reduction of inflammation around atherosclerotic plaques. In addition, esmolol (Biblok) is able to reduce intra- and postoperative use of opioids, and therefore its use as a component of multimodal total intravenous anesthesia has been proposed. Preoperative administration of esmolol may also be an effective and safe method of myocardial protection in patients undergoing cardiac surgery. β-blockers are well tolerated in patients with acute hypovolaemia during anesthesia, however, episodes of hypercapnia should be avoided during their use.
 Conclusions. 1. For the optimal POM, the individual risk of perioperative complications should be determined. 2. POM includes a number of pre-, intra- and postoperative measures. 3. The use of ultrashort-acting β-blocker esmolol prevents intraoperative myocardial ischemia, has antioxidant and anti-inflammatory effects, reduces the need for opioids.

Intermittent antegrade warm-blood versus cold-blood cardioplegia in children undergoing open heart surgery: a protocol for a randomised controlled study (Thermic-3)

IntroductionSurgical repair of congenital heart defects often requires the use of cardiopulmonary bypass (CPB) and cardioplegic arrest. Cardioplegia is used during cardiac surgery requiring CPB to keep the heart still...

Incidental retroaortic innominate vein in a patient with acute aortic dissection

BackgroundRetroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare.Case presentationA 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement.ConclusionsAttention must be paid to the cannulation site for venous uptake and the method of myocardial protection.

Cardio-Protective Effects of Multiport Antegrade Cold Blood Cardioplegia Versus Antegrade Cold Blood Cardioplegia in Patients With Left Ventricular Systolic Dysfunction Undergoing Conventional Coronary Artery Bypass Grafting.

IntroductionThe aim of this study was to compare the in-hospital outcomes of multiport antegrade cold blood cardioplegia through vein grafts versus conventional antegrade cold blood cardioplegia in patients with left ventricle systolic dysfunction who underwent coronary artery bypass grafting (CABG).MethodsThis prospective, randomized clinical study was comprised of patients undergoing on-pump CABG at the Ch. Pervaiz Elahi Institute of Cardiology in Multan, Pakistan from November 18, 2018 to December 17, 2019. Patients with multivessel coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 50%) were included. In Group A (N = 73), multiport antegrade cold blood vein graft cardioplegia was given after every distal anastomosis completed for myocardial preservation. In Group B (N = 73), conventional antegrade cold blood cardioplegia was given for myocardial preservation.ResultsSpontaneous rhythm (without defibrillation applied) after cross-clamp removal was higher in Group A than in Group B (93.3% vs. 85.2%, p < 0.05). Duration of support, ventilation time, and hospital stay were also significantly lower in Group A than in Group B with p = 0.00001, p = 0.03, and p = 0.002, respectively. Intra-aortic balloon pump insertion (4.1% vs. 23.0%, p = 0.02) and operative mortality (0.5% vs. 4.0%, p = 0.35) were also lower in Group A than in Group B. Postoperative left ventricular ejection fraction (LVEF) increased more in Group A than in Group B, and the postoperative LVEF mean value was 44.68% in Group A versus 41.26% in Group B (p = 0.02).ConclusionMultiport vein graft blood cardioplegia provides superior myocardial protection in patients with left ventricular systolic dysfunction who underwent CABG. It is also easy to administer, so this technique can be adopted as a routine method for myocardial protection in patients with left ventricular dysfunction planned for on-pump CABG.