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Irqsusi M, Loos D, Dielmann K, Ramzan R, Wulf H, Ghazy T, Vogt S, Rastan AJ. Influence of cardioplegic solution on incidence of delirium after CABG surgery: Use of Calafiore blood cardioplegia versus HTK - Bretschneider - solution in a single-center retrospective analysis from 2017 to 2021. J Card Surg 2022; 37:4670-4678. [PMID: 36321752 DOI: 10.1111/jocs.17059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Purpose of the present study is an evaluation of postoperative incidence for delirium after coronary artery bypass surgery (CABG). Study addressed whether application of Histidine-Tryptophan-Ketoglutarate (HTK) solution (Bretschneider) or blood cardioplegia (Calafiore) is associated with increased of postoperative delirium cases. MATERIALS AND METHODS In a retrospective, single center evaluation a total number of 273 patients were enrolled in the study from January 2017 to October 2021. There were 124 patients assigned to the Calafiore group blood cardioplegic solution (BCC) and 149 patients were included in the Bretschneider group (HTK). The primary endpoint was the postoperative delirium rate in its frequency of occurrence. Definition of the dilirium status was performed using the Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) score during the first three postoperative days. Secondary endpoints were the time intervals of intensive care duration of stay, mechanical ventilation, total extracorporeal circulation, ischemia and reperfusion. Serum levels of the electrolytes Sodium, Potassium, ionized Calcium, and Chloride were monitored. RESULTS Although no significant difference in delirium status between the groups were noticed, on third postoperative day, delirium rate dependent on cardioplegia solution used (HTK 12.0%; BCC 3.0%; p = .024) and duration of intensive care stay differed (HTK 4.5 vs. BCC 3.0 days; p = .001). Although Ischemic time (HTK 73.0 vs. BCC 83.0 min; p < .001) and reperfusion time (HTK 35.0 vs. Calafiore 24.0 min; p < .001) were extended in the BCC group less cases of delirium were diagnosed. Serum sodium levels after HTK cardioplegic infusion were decreased (HTK 129.68 vs. BCC 138.96 mmol/l; p < .001). The significant difference persists up to the hundredth extracorporeal circulation circuit min (p = .005). CONCLUSION The present data suggest an impact of the cardioplegic solution used upon postoperative delirium rates. Optimization of cardiac arrest protocols is needed. Present data encourage further prospective studies regarding the impact of cardioplegic solutions on electrolyte imbalance for postoperative delirium rates in CABG surgery.
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Affiliation(s)
- Marc Irqsusi
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany
| | - Dominik Loos
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany
| | - Kai Dielmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany
| | - Rabia Ramzan
- Bioenergetic Res Lab, Heart Center, Philipps-University, Marburg, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany
| | - Tamer Ghazy
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany
| | - Sebastian Vogt
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany.,Bioenergetic Res Lab, Heart Center, Philipps-University, Marburg, Germany
| | - Ardawan J Rastan
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Baldingerstrasse, Germany
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James TM, Nores M, Rousou JA, Lin N, Stamou SC. Warm Blood Cardioplegia for Myocardial Protection: Concepts and Controversies. Tex Heart Inst J 2020; 47:108-116. [PMID: 32603472 DOI: 10.14503/thij-18-6909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Warm blood cardioplegia has been an established cardioplegic method since the 1990s, yet it remains controversial in regard to myocardial protection. This review will describe the physiologic and technical concepts behind warm blood cardioplegia, as well as outline the current basic and clinical research that evaluates its usefulness. Controversies regarding this technique will also be reviewed. A long history of experimental data indicates that warm blood cardioplegia is safe and effective and thus suitable myocardial protection during cardiopulmonary bypass surgeries.
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Affiliation(s)
- Taylor M James
- Graduate Medical Education MD/MPH Program, University of Miami Miller School of Medicine, Miami, Florida 33130
| | - Marcos Nores
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida 33462
| | - John A Rousou
- Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts 01199
| | - Nicole Lin
- Graduate Medical Education MD/MPH Program, University of Miami Miller School of Medicine, Miami, Florida 33130
| | - Sotiris C Stamou
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida 33462
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Saclı H, Kara I, Diler MS, Percin B, Turan AI, Kırali K. The Relationship between the Use of Cold and Isothermic Blood Cardioplegia Solution for Myocardial Protection during Cardiopulmonary Bypass and the Ischemia-Reperfusion Injury. Ann Thorac Cardiovasc Surg 2019; 25:296-303. [PMID: 31308305 PMCID: PMC6923728 DOI: 10.5761/atcs.oa.18-00293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In this study, we aimed to assess myocardial protection and ischemia-reperfusion injury in patients undergoing open heart surgery with isothermic blood cardioplegia (IBC) or hypothermic blood cardioplegia (HBC). MATERIALS AND METHODS A total of 48 patients who underwent isolated coronary artery bypass grafting or isolated mitral valve surgery between March 2017 and October 2017 were evaluated as randomized prospective study. Study groups (HBC: Group 1, IBC: Group 2) were compared in terms of interleukin 6 (IL-6), IL-8, IL-10, and complement factor 3a (C3a) levels, metabolic parameters, creatine kinase-muscle/brain (CK-MB) and high-sensitivity Troponin I (hsTn-I), and clinical outcomes. RESULTS Comparison of the markers of ischemia-reperfusion injury showed significantly higher levels of the proinflammatory cytokine IL-6 in the early postoperative period as well as IL-8, in Group 2 (p <0.001), whereas the anti-inflammatory cytokine IL-10 was significantly higher during the X1 time period (p = 0.11) in Group 2, and subsequently it was higher in Group 1. Using myocardial temperature probes, the target myocardial temperatures were measured in the patients undergoing open heart surgery with different routes of cardioplegia, and significant differences were noted (p = 0.000). CONCLUSION HBC for open heart surgery is associated with less myocardial injury and intraoperative and postoperative morbidity, indicating superior myocardial protection versus IBC.
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Affiliation(s)
- Hakan Saclı
- Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya University, Adapazarı, Turkey
| | - Ibrahim Kara
- Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya University, Adapazarı, Turkey
| | - Mevriye Serpil Diler
- Department of Cardiovascular Surgery, Sakarya University Education and Research Hospital, Adapazarı, Turkey
| | - Bilal Percin
- Department of Cardiovascular Surgery, Sakarya University Education and Research Hospital, Adapazarı, Turkey
| | - Ahmet Ilksoy Turan
- Department of Cardiovascular Surgery, Sakarya University Education and Research Hospital, Adapazarı, Turkey
| | - Kaan Kırali
- Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya University, Adapazarı, Turkey
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Boening A, Assling-Simon L, Heep M, Boengler K, Niemann B, Schipke J, Mühlfeld C, Grieshaber P. Blood cardioplegia for cardiac surgery in acute myocardial infarction: rat experiments with two widely used solutions. Interact Cardiovasc Thorac Surg 2019; 27:88-94. [PMID: 29452370 DOI: 10.1093/icvts/ivy011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/06/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Blood cardioplegia (BCP) can be used in different ways to protect the heart from ischaemia-reperfusion injury during cardiac surgery. Because there could be differences between warm and cold intermittent cardioplegia with or without warm reperfusion, we investigated the influence of 2 blood cardioplegia solutions on cardiac function, metabolism and infarct size in stable and infarcted rat hearts. METHODS The hearts of 32 male Wistar rats were excised and inserted into a blood-perfused isolated heart apparatus. In 16 hearts, an acute myocardial infarction was induced by ligation of the left anterior descending coronary artery at least 30 min before aortic clamping. After aortic clamping, either Calafiore or Buckberg BCP was administered. During reperfusion, coronary blood flow, left ventricular developed pressure and dp/dt max were recorded, and oxygen consumption and lactate production were determined. The infarct size after 90 min of reperfusion was measured by triphenyl tetrazolium chloride staining. The hearts of rats without infarction were investigated using transmission electron microscopy. RESULTS In hearts without infarction, haemodynamic recovery was similar for Calafiore and Buckberg solutions: left ventricular developed pressure [Cala 62% of baseline (BL), Buck 58% BL] and dp/dt max (Cala 83% BL, Buck 89% BL). Coronary flow, which was slightly less in infarcted hearts, also recovered similarly after the administration of the 2 BCP solutions (Cala 65% BL, Buck 68% BL). During reperfusion, lactate production was similar (Cala 0.85 ml/min, Buck 1.0 ml/min), and the cellular oedema index and mitochondrial swelling were comparable between the 2 groups. In hearts with infarction, left ventricular developed pressure (Cala 58% BL, Buck 56% BL) and dp/dt max (Cala 79% BL, Buck 72% BL) showed similar recovery for reperfusion with Calafiore or Buckberg BCP. In addition, coronary flow recovered similarly (Cala 54% BL, Buck 57% BL). During reperfusion, myocardial oxygen consumption was lower in the Cala (67% BL) than in the Buck (82% BL) group, but lactate production was similar between the Cala (1.1 ml/min) and the Buck (1.1 ml/min) groups. Myocardial infarct size was also similar in the Cala group (24%) and in the Buck group (26%). CONCLUSIONS In stable perfused rat hearts and in an in vitro model of acute myocardial infarction, the 2 BCP solutions offer equally good myocardial protection.
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Affiliation(s)
- Andreas Boening
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Lena Assling-Simon
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Martina Heep
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Kerstin Boengler
- Department of Physiology, Justus Liebig University, Giessen, Germany
| | - Bernd Niemann
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Julia Schipke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Philippe Grieshaber
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
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Nardi P, Vacirca SR, Russo M, Colella DF, Bassano C, Scafuri A, Pellegrino A, Melino G, Ruvolo G. Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement. J Thorac Dis 2018; 10:1490-1499. [PMID: 29707299 DOI: 10.21037/jtd.2018.03.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. Fewer studies have been carried out of patients affected by left ventricular hypertrophy, where the choice of type and temperature of cardioplegia remain controversial. We have retrospectively investigated myocardial injury and short-term outcome in patients undergoing aortic valve replacement plus or minus coronary artery bypass grafting with using cold crystalloid cardioplegia (CCC) or warm blood cardioplegia (WBC). Methods From January 2015 to October 2016, 191 consecutive patients underwent aortic valve replacement plus or minus coronary artery bypass grafting in normothermic cardiopulmonary bypass. Cardiac arrest was obtained with use of intermittent antegrade CCC group (n=32) or WBC group (n=159), according with the choice of the surgeon. Results As compared with WBC group, in CCC group creatine-kinase-MB (CK-MB), cardiac troponin I (cTnI), aspartate aminotransferase (AST) release, and their peak levels, were lower during each time points of evaluation, with the greater statistically significant difference at time 0 (P<0.05, for all comparisons). A time 0, CK-MB/CK ratio >10% was 5.9% in CCC group versus 7.8% in WBC group (P<0.0001). At time 0 CK-MB/CK ratio >10% in patients undergoing isolated aortic valve replacement was 6.0% in CCC group versus 8.0% in WBC group (P<0.01). No any difference was found in perioperative myocardial infarction (0% versus 3.8%), postoperative (PO) major complications (15.6% versus 16.4%), in-hospital mortality (3.1% versus 1.3%). Conclusions In aortic valve surgery a significant decrease of myocardial enzymes release is observed in favor of CCC, but this difference does not translate into different clinical outcome. However, this study suggests that in presence of cardiac surgical conditions associated with significant left ventricular hypertrophy, i.e., the aortic valve disease, a better myocardial protection can be achieved with the use of a cold rather than a warm cardioplegia. Therefore, CCC can be still safely used.
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Affiliation(s)
- Paolo Nardi
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Sara R Vacirca
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Marco Russo
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Dionisio F Colella
- Division of Anesthesiology, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Carlo Bassano
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Antonio Scafuri
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Antonio Pellegrino
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Gerry Melino
- Department of Experimental Medicine and Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Giovanni Ruvolo
- Division of Cardiac Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy
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Warm blood cardioplegia versus cold crystalloid cardioplegia for myocardial protection during coronary artery bypass grafting surgery. Cell Death Discov 2018. [PMID: 29531820 PMCID: PMC5841304 DOI: 10.1038/s41420-018-0031-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We retrospectively analyzed early results of coronary artery bypass grafting (CABG) surgery using two different types of cardioplegia for myocardial protection: antegrade intermittent warm blood or cold crystalloid cardioplegia. From January 2015 to October 2016, 330 consecutive patients underwent isolated on-pump CABG. Cardiac arrest was obtained with use of warm blood cardioplegia (WBC group, n = 297) or cold crystalloid cardioplegia (CCC group, n = 33), according to the choice of the surgeon. Euroscore II and preoperative characteristics were similar in both groups, except for the creatinine clearance, slightly lower in WBC group (77.33 ± 27.86 mL/min versus 88.77 ± 51.02 mL/min) (P < 0.05). Complete revascularization was achieved in both groups. In-hospital mortality was 2.0% (n = 6) in WBC group, absent in CCC group. The required mean number of cardioplegia’s doses per patient was higher in WBC group (2.3 ± 0.8) versus CCC group (2.0 ± 0.7) (P = 0.045), despite a lower number of distal coronary artery anastomoses (2.7 ± 0.8 versus 3.2 ± 0.9) (P = 0.0001). Cardiopulmonary and aortic cross-clamp times were similar in both groups. The incidence of perioperative myocardial infarction (WBC group 3.4% versus CCC group 3.0%) and low cardiac output syndrome (4.4% versus 3.0%) were similar in both groups. As compared with WBC group, in CCC group CK-MB/CK ratio >10% was lower during each time points of evaluation, with a statistical significant difference at time 0 (4% ± 1.6% versus 5% ± 2.5%) (P = 0.021). In presence of complete revascularization, despite the value of CK-MB/CK ratio >10% was less in the CCC group, clinical results were not affected by both types of cardioplegia adopted to myocardial protection. As compared with cold crystalloid, warm blood cardioplegia requires a shorter interval of administration to achieve better myocardial protection.
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Crawford TC, Carter MV, Patel RK, Suarez-Pierre A, Lin SZ, Magruder JT, Grimm JC, Cameron DE, Baumgartner WA, Mandal K. Management of sickle cell disease in patients undergoing cardiac surgery. J Card Surg 2017; 32:80-84. [DOI: 10.1111/jocs.13093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Todd C. Crawford
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Michael V. Carter
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Rina K. Patel
- Division of Hematology, Department of Medicine; Greater Baltimore Medical Center; Baltimore Maryland
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Sophie Z. Lin
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Jonathan Trent Magruder
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Joshua C. Grimm
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Duke E. Cameron
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - William A. Baumgartner
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Kaushik Mandal
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
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Stoliński J, Plicner D, Grudzień G, Wąsowicz M, Musiał R, Andres J, Kapelak B. A comparison of minimally invasive and standard aortic valve replacement. J Thorac Cardiovasc Surg 2016; 152:1030-9. [PMID: 27449562 DOI: 10.1016/j.jtcvs.2016.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/20/2016] [Accepted: 06/12/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The study objective was to compare aortic valve replacement through a right anterior minithoracotomy with aortic valve replacement through a median sternotomy. METHODS With propensity score matching, we selected 211 patients after aortic valve replacement through a right anterior minithoracotomy and 211 patients after aortic valve replacement who underwent operation between January 2010 and December 2013. Perioperative outcomes were analyzed, and multivariable logistic regression analysis of risk factors of postoperative morbidity was performed. RESULTS For propensity score-matched patients, hospital mortality was 1.0% in the aortic valve replacement through a right anterior minithoracotomy group and 1.4% in the aortic valve replacement group (P = 1.000). Stroke occurred in 0.5% versus 1.4% (P = .615), myocardial infarction occurred in 1.4% versus 1.9% (P = 1.000), and new onset of atrial fibrillation occurred in 12.8% versus 24.2% (P = .003) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Postoperative drainage was 353.5 ± 248.6 mL versus 544.3 ± 324.5 mL (P < .001) and blood transfusion was required for 48.8% versus 67.3% (P < .001) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Mediastinitis occurred in 2.8% of patients after aortic valve replacement and in 0.0% of patients after aortic valve replacement through a right anterior minithoracotomy surgery (P = .040). Intensive care unit stay (1.3 ± 1.2 days vs 2.6 ± 2.6 days) and hospital stay (5.7 ± 1.6 days vs 8.7 ± 4.4 days) were statistically significantly shorter in the aortic valve replacement through a right anterior minithoracotomy group. Aortic valve replacement through a right anterior minithoracotomy surgery resulted in reduced postoperative morbidity (odds ratio, 0.4; P < .001) and postoperative bleeding and blood transfusion requirements (odds ratio, 0.4; P < .001). CONCLUSIONS Aortic valve replacement through a right anterior minithoracotomy surgery resulted in a reduced infection rate, diminished postoperative bleeding and blood transfusion requirements, reduced occurrence of new onset of atrial fibrillation, and shorter intensive care unit and hospital stays.
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Affiliation(s)
- Jarosław Stoliński
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
| | - Dariusz Plicner
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Grzegorz Grudzień
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Marcin Wąsowicz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Musiał
- Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Janusz Andres
- Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
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Patel PA, Ghadimi K, Coetzee E, Myburgh A, Swanevelder J, Gutsche JT, Augoustides JGT. Incidental Cold Agglutinins in Cardiac Surgery: Intraoperative Surprises and Team-Based Problem-Solving Strategies During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 31:1109-1118. [PMID: 27624931 DOI: 10.1053/j.jvca.2016.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Divisions of Cardiothoracic Anesthesiology and Critical Care, Anesthesiology and Critical Care, Duke University Medical Center, Durham, NC
| | - Ettienne Coetzee
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adriaan Myburgh
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Cardiothoracic Anesthesia, Department of Anesthesia and Perioperative Medicine, School of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Zeriouh M, Heider A, Rahmanian PB, Choi YH, Sabashnikov A, Scherner M, Popov AF, Weymann A, Ghodsizad A, Deppe AC, Kröner A, Kuhn-Régnier F, Wippermann J, Wahlers T. Six-years survival and predictors of mortality after CABG using cold vs. warm blood cardioplegia in elective and emergent settings. J Cardiothorac Surg 2015; 10:180. [PMID: 26637200 PMCID: PMC4670537 DOI: 10.1186/s13019-015-0384-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 11/18/2015] [Indexed: 12/26/2022] Open
Abstract
Background The aim of this study was to determine whether intermittent warm blood cardioplegia (IWC) is associated with comparable myocardial protection compared to cold blood cardioplegia (ICC) in patients undergoing elective vs. emergent CABG procedures. Methods Out of 2292 consecutive patients who underwent isolated on-pump CABG surgery using cardioplegic arrest either with ICC or IWC between January 2008 and December 2010, 247 consecutive emergent patients were identified and consecutively matched 1:2 with elective patients based on gender, age (<50 years, 50–70 years, >70 years) and ejection fraction (<40 %, 40–50 %, >50 %). Perioperative outcomes and long-term mortality were compared between ICC and IWC strategies and predictors for 30-day mortality and perioperative myocardial injury were identified in both elective and emergent subgroups of patients. Results Preoperative demographics and baseline characteristics, logistic Euroscore, CPB-time, number of distal anastomoses and LIMA-use were comparable. Aortic cross clamp time was significantly longer in the IWC-group regardless of the urgency of the procedure (p = 0.05 and p = 0.015 for emergent and elective settings). There were no significant differences regarding ICU-stay, ventilation time, total blood loss and need for dialysis. The overall 30-day, 1-, 3- and 6-year survival of the entire patient cohort was 93.7, 91.8, 90.4 and 89.1 %, respectively, with significantly better outcomes when operated electively (p < 0.001) but no differences between ICC and IWC both in elective (p = 0.857) and emergent (p = 0.741) subgroups. Multivariate analysis did not identify the type of cardioplegia as a predictor for 30-day mortality and for perioperative myocardial injury. However, independent factors predictive of 30-day mortality were: EF < 40 % (OR 3.66; 95 % CI: 1.79–7.52; p < 0.001), atrial fibrillation (OR 3.33; 95 % CI: 1.49-7.47; p < 0.003), peripheral artery disease (OR 2.51; 95 % CI: 1.13–5.55; p < 0.023) and COPD (OR 0.26; 95 % CI: 1.05–6.21; p < 0.038); predictors for perioperative myocardial infarction were EF < 40 % (OR 2.04; 95 % CI: 1.32–3.15; p < 0.001), preoperative IABP support (OR 3.68; 95 % CI: 1.34-10.13; p < 0.012), and hemofiltration (OR 3.61; 95 % CI: 2.22–5.87; p < 0.001). Conclusion Although the aortic cross clamp time was prolonged in the IWC group our results confirm effective myocardial protection under IWC, regardless of the urgency of the procedure. We suggest that intermittent warm cardioplegia in emergent CABG setting is a low-cost alternative and safe. It is associated with similar long-term outcomes both in elective and emergent settings compared to intermittent cold cardioplegia.
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Affiliation(s)
- Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Ammar Heider
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximillian Scherner
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Alexander Weymann
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Ghodsizad
- Heart and Vascular Institute, Pennstate Hershey, Philadelphia, PA, USA
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Axel Kröner
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Hansen LS, Sloth E, Hjortdal VE, Jakobsen CJ. Follow-Up After Cardiac Surgery Should be Extended to at Least 120 Days When Benchmarking Cardiac Surgery Centers. J Cardiothorac Vasc Anesth 2015; 29:984-9. [DOI: 10.1053/j.jvca.2014.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Indexed: 11/11/2022]
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Raicea V, Kovacs J, Moraru L, Suciu H. Coronary Sinus Lactate as Marker of Myocardial Ischemia in Cardiac Surgery: Correlation with Morbidity and Mortality after Cardiac Surgery / Lactatul din sinusul coronarian - marker al ischemiei miocardice în chirurgia cardiacă: corelaţii cu morbiditatea şi mortalitatea postoperatorie. REV ROMANA MED LAB 2015. [DOI: 10.1515/rrlm-2015-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractIntroduction. Perioperative myocardial injuries are one of the most frequent causes of morbidity and mortality after cardiac surgery, the most common etiology being the poor myocardial protection during aortic crossclamp. During aortic crossclamp progressive accumulation of lactate and intracellular acidosis are well-known phenomena, and are associated with alteration of myocardial contractile function. Our objective was to study the coronary sinus lactate levels as a predictor of postoperative hemodynamic outcome in open-heart surgical patients.Material and methods. We performed a prospective clinical trial, including 142 adult patients with elective cardiac surgery. Anterograde cardioplegia was administered in 82 patients, retrograde cardioplegia in 60 (in 30 patients it was administrated intermittently and in 30 continuously). Blood was collected simultaneously from the aortic cardioplegic line (inflow) and from coronary sinus or the aortic root (outflow) before aortic crossclamp, after crossclamp at every 10 minutes and after crossclamp removal at 0 and 10 minutes. All patients were operated on cardiopulmonary bypass with cardiac arrest, using warm-blood cardioplegia for cardioprotection.Results. Lactate levels showed increasing values during aortic crossclamp, and a rapid decline after crossclamp removal. The incidence of low cardiac output was significantly higher in patients with lactate levels that exceeded 4 mmol/L. In patients who died in the postoperative period, lactate level was even higher (5 mmol/L), with only a modest recovery after crossclamp removal.Conclusion. Monitoring lactate level in coronary sinus blood is a reliable method and has a good prognostic value regarding postoperative morbidity and mortality in open heart surgery
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Durukan AB, Gurbuz HA, Tavlasoglu M, Ucar HI, Yorgancioglu C. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions. J Tehran Heart Cent 2015; 10:43-5. [PMID: 26157462 PMCID: PMC4494518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 04/15/2013] [Indexed: 12/02/2022] Open
Abstract
Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous.
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Affiliation(s)
- Ahmet Baris Durukan
- Medicana International Ankara Hospital, Department of Cardiovascular Surgery, Ankara, Turkey.,Corresponding Author: Ahmet Baris Durukan, Associate Professor of Cardiovascular Surgery, Medicana International Ankara Hospital, Umit Mahallesi, 2463, Sokak 4/18, 06810, Yenimahalle, Ankara, Turkey. Tel: +90 532 2273814. Fax: +90 312 2203170. E-mail:
| | - Hasan Alper Gurbuz
- Medicana International Ankara Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
| | - Murat Tavlasoglu
- Diyarbakir Military Hospital, Department of Cardiovascular Surgery, Diyarbakir, Turkey
| | - Halil Ibrahim Ucar
- Medicana International Ankara Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
| | - Cem Yorgancioglu
- Medicana International Ankara Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
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Münch F, Purbojo A, Kellermann S, Janssen C, Cesnjevar RA, Rüffer A. Improved contractility with tepid modified full blood cardioplegia compared with cold crystalloid cardioplegia in a piglet model. Eur J Cardiothorac Surg 2014; 48:236-43. [PMID: 25414425 DOI: 10.1093/ejcts/ezu440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/19/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Experience regarding warm blood cardioplegia according to Calafiore results from its broad use in adult patients. In this experimental study, tepid (28°C) modified full blood cardioplegia (MBC) was adopted for paediatric use and compared with cold crystalloid cardioplegia (CCC). METHODS Twenty male piglets (mean weight: 11.1 ± 1.0 kg) were operated on cardiopulmonary bypass (CPB) in moderate hypothermia (28°C) and randomized to MBC (n = 8) or CCC (n = 12) for 60 min aortic cross-clamping. Blood levels of myocardial proteins [N-terminal pro-brain natriuretic peptide (NT-pro-BNP), myoglobin, creatine kinase type MB and troponin-I] were investigated at the beginning of the experiment and after CPB. Haemodynamic measurements included thermodilution and conductance-catheter technique inserted through the left ventricle-apex. Pressure-volume loop analysis was performed with dobutamine-stress test and inflow occlusion, enabling preload independent evaluation of myocardial performance. Changes of measured data post-CPB were calculated in relation to baseline-levels (%). RESULTS Baseline and operative data in both groups were similar. During the experiment, cardiac markers showed no significant variations between groups. Pressure-volume loop analysis during stress test revealed a significantly higher preload independent contractility (slope of end-systolic pressure-volume relation: Ees) with MBC compared with CCC (MBC: 123 ± 35% [confidence interval (CI95): 93-153] vs CCC: 78 ± 34% [CI95: 54-102]; P = 0.042), whereas cardiac output was not significantly different between groups {MBC: 122 ± 16% [95% confidence interval (CI95): 109-135] vs CCC: 105 ± 17% [CI95: 93-116]; P = 0.069}. CONCLUSION This randomized animal study proves feasibility and safety of MBC for paediatric use. Haemodynamic evaluation and cardiac markers did not show inferiority to standard CCC. Moreover, MBC seems to be associated with superior contractility post bypass, which encourages us to use MBC in paediatric patients in the near future.
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Affiliation(s)
- Frank Münch
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Ariawan Purbojo
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Stephanie Kellermann
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Carina Janssen
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Robert Anton Cesnjevar
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - André Rüffer
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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QIAN YUANYU, LIU JIE, MA JINLING, MENG QINGYI, PENG CHAOYING. Effect of initial temperature changes on myocardial enzyme levels and cardiac function in acute myocardial infarction. Exp Ther Med 2014; 8:243-247. [PMID: 24944629 PMCID: PMC4061241 DOI: 10.3892/etm.2014.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 01/30/2014] [Indexed: 11/15/2022] Open
Abstract
In the present study, the effect of initial body temperature changes on myocardial enzyme levels and cardiac function in acute myocardial infarction (AMI) patients was investigated. A total of 315 AMI patients were enrolled and the mean temperature was calculated based on their body temperature within 24 h of admission to hospital. The patients were divided into four groups according to their normal body temperature: Group A, <36.5°C; group B, ≥36.5°C and <37.0°C; group C, ≥37.0°C and <37.5°C and group D, ≥37.5°C. The levels of percutaneous coronary intervention, myocardial enzymes and troponin T (TNT), as well as cardiac ultrasound images, were analyzed. Statistically significant differences in the quantity of creatine kinase at 12 and 24 h following admission were identified between group A and groups C and D (P<0.01). A significant difference in TNT at 12 h following admission was observed between groups A and D (P<0.05), however, this difference was not observed with groups B and C. The difference in TNT between the groups at 24 h following admission was not statistically significant (P>0.05). Significant differences in lactate dehydrogenase at 12 and 24 h following admission were observed between groups A and D (P<0.05), however, differences were not observed with groups B and C (P>0.05). Significant differences in glutamic-oxaloacetic transaminase at 12 and 24 h following admission were observed between groups A and D (P<0.05), however, differences were not observed in groups B and C (P>0.05). However, no significant differences were identified in cardiac function index between all the groups. Therefore, the results of the present study indicated that AMI patients with low initial body temperatures exhibited decreased levels of myocardial enzymes and TNT. Thus, the observation of an initially low body temperature may be used as a protective factor for AMI and may improve the existing clinical program.
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Patel PA, Desai ND. Con: Cardiac surgery should be performed under warm conditions. J Cardiothorac Vasc Anesth 2012; 26:949-51. [PMID: 22790159 DOI: 10.1053/j.jvca.2012.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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