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Zhou Y, Hao Y, Sun P, Chen M, Zhang T, Wu H. Relationship among surface electric double layer of cardiomyocyte membrane and toxicology of digoxin and opening of ion channels. Sci Rep 2022; 12:20749. [PMID: 36456624 PMCID: PMC9715572 DOI: 10.1038/s41598-022-25205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
We applied a new idea that the potential effect can change the ion adsorption structure on the cell surface to explore the mechanism of digoxin poisoning and the regulation of ion channels. The effects of digoxin on the electrophoretic mobility and behaviors (non-contraction or contraction or autorhythmicity) of cardiomyocytes were observed by single-cell electrophoresis technique (imitate the opening method of in vivo channel) and the method of decomposing surface potential components on the cells. As well as affect the association with electrical activity. The results suggested that the increase of cardiomyocytes transmembrane potential and the Na+-K+ exchange on the cell surface of the action potential phase 4 caused by the poisoning dose of digoxin, leading to the oscillation of adsorbed ions on the cell surface and the incomplete channel structure, which were the mechanism of cardiac ectopic beats. The results revealed that the opening of ion channels is regulated by the surface electric double layer of the cell membrane.
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Affiliation(s)
- Ying Zhou
- grid.414252.40000 0004 1761 8894The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, 100142 China
| | - Yanfei Hao
- grid.414252.40000 0004 1761 8894The Eighth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, 100091 China
| | - Pei Sun
- grid.414252.40000 0004 1761 8894The Eighth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, 100091 China
| | - Ming Chen
- grid.414252.40000 0004 1761 8894The Medical Security Center, Chinese People’s Liberation Army General Hospital, Beijing, 100039 China
| | - Ting Zhang
- grid.414252.40000 0004 1761 8894The Eighth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, 100091 China
| | - Hong Wu
- grid.414252.40000 0004 1761 8894The Medical Security Center, Chinese People’s Liberation Army General Hospital, Beijing, 100039 China
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Tan J, Bi S, Li J, Gu J, Wang Y, Xiong J, Yu X, Du L. Comparative effects of different types of cardioplegia in cardiac surgery: A network meta-analysis. Front Cardiovasc Med 2022; 9:996744. [PMID: 36176979 PMCID: PMC9513158 DOI: 10.3389/fcvm.2022.996744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare the outcomes of four types of cardioplegia during cardiac surgery: del Nido (DN), blood cardioplegia (BC), histidine-tryptophan-ketoglutarate (HTK) and St. Thomas.MethodsRandomized controlled trials (RCTs) and observational cohort studies from 2005 to 2021 were identified in PubMed, Embase, and Cochrane databases. Data were extracted for the primary endpoint of perioperative mortality as well as the following secondary endpoints: atrial fibrillation, renal failure, stroke, use of an intra-aortic balloon pump, re-exploration, intensive care unit stay and hospital stay. A network meta-analysis comparing all four types of cardioplegia was performed, as well as direct meta-analysis comparing pairs of cardioplegia types.ResultsData were extracted from 18 RCTs and 49 observational cohort studies involving 18,191 adult patients (55 studies) and 1,634 children (12 studies). Among adult patients, risk of mortality was significantly higher for HTK (1.89, 95% CI 1.10, 3.52) and BC (RR 1.73, 95% CI 1.22, 2.79) than for DN. Risk of atrial fibrillation was significantly higher for BC (RR 1.41, 95% CI 1.09, 1.86) and DN (RR 1.51, 95% CI 1.15, 2.03) than for HTK. Among pediatric patients, no significant differences in endpoints were observed among the four types of cardioplegia.ConclusionsThis network meta-analysis suggests that among adult patients undergoing cardiac surgery, DN may be associated with lower perioperative mortality than HTK or BC, while risk of atrial fibrillation may be lower with HTK than with BC or DN.
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Affiliation(s)
- Jia Tan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Siwei Bi
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingyi Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yishun Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiyue Xiong
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Du
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Du
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Abstract
Potassium homeostasis affects cardiac rhythm and contractility, along with vascular reactivity and vascular smooth muscle proliferation. This chapter will focus on potassium dynamics during and after cardiac surgery involving cardioplegic arrest and cardiopulmonary bypass (CPB). Hyperkalemic, hypothermic solutions are frequently used to induce cardioplegic arrest and protect the heart during cardiac surgery involving CPB. Common consequences of hyperkalemic cardioplegic arrest and reperfusion include microvascular dysfunction involving several organ systems and myocardial dysfunction. Immediately after CPB, blood potassium levels often drop precipitously due to a variety of factors, including CPB -induced electrolyte depletion and frequent, long-term administration of insulin during and after surgery. Meanwhile, some patients with pre-existing kidney dysfunction may experience postoperative hyperkalemia following cardioplegia. Any degree of postoperative hyper/hypokalemia significantly elevates the risk of cardiac arrythmias and subsequent myocardial failure. Therefore, proper management of blood potassium levels during and after cardioplegia/CPB is crucial for optimizing patient outcomes following cardiac surgery.
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Krasniqi L, Ipsen MH, Schrøder HD, Hejbøl EK, Rojek AM, Kjeldsen BJ, Riber LP. Stone heart syndrome after prolonged cardioplegia induced cardiac arrest in open-heart surgery – a pilot study on pigs. Cardiovasc Pathol 2022; 60:107427. [DOI: 10.1016/j.carpath.2022.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/25/2022] Open
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Veitinger AB, Komguem A, Assling-Simon L, Heep M, Schipke J, Mühlfeld C, Niemann B, Grieshaber P, Boengler K, Böning A. Cardioprotection with esmolol-based cardioplegia for non-infarcted and infarcted rat hearts. Eur J Cardiothorac Surg 2021; 60:908-917. [PMID: 33709143 DOI: 10.1093/ejcts/ezab117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Esmolol-based cardioplegic arrest offers better cardioprotection than crystalloid cardioplegia but has been compared experimentally with blood cardioplegia only once. We investigated the influence of esmolol crystalloid cardioplegia (ECCP), esmolol blood cardioplegia (EBCP) and Calafiore blood cardioplegia (Cala) on cardiac function, metabolism and infarct size in non-infarcted and infarcted isolated rat hearts. METHODS Two studies were performed: (i) the hearts were subjected to a 90-min cardioplegic arrest with ECCP, EBCP or Cala and (ii) a regional myocardial infarction was created 30 min before a 90-min cardioplegic arrest. Left ventricular peak developed pressure (LVpdP), velocity of contractility (dLVP/dtmax), velocity of relaxation over time (dLVP/dtmin), heart rate and coronary flow were recorded. In addition, the metabolic parameters were analysed. The infarct size was determined by planimetry, and the myocardial damage was determined by electron microscopy. RESULTS In non-infarcted hearts, cardiac function was better preserved with ECCP than with EBCP or Cala relative to baseline values (LVpdP: 100 ± 28% vs 86 ± 11% vs 57 ± 7%; P = 0.002). Infarcted hearts showed similar haemodynamic recovery for ECCP, EBCP and Cala (LVpdP: 85 ± 46% vs 89 ± 55% vs 56 ± 26%; P = 0.30). The lactate production with EBCP was lower than with ECCP (0.6 ± 0.7 vs 1.4 ± 0.5 μmol/min; P = 0.017). The myocardial infarct size and (ECCP vs EBCP vs Cala: 16 ± 7% vs 15 ± 9% vs 24 ± 13%; P = 0.21) the ultrastructural preservation was similar in all groups. CONCLUSIONS In non-infarcted rat hearts, esmolol-based cardioplegia, particularly ECCP, offers better myocardial protection than Calafiore. After an acute myocardial infarction, cardioprotection with esmolol-based cardioplegia is similar to that with Calafiore.
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Affiliation(s)
| | - Audrey Komguem
- 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
| | - Julia Schipke
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | - Christian Mühlfeld
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | - Bernd Niemann
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Philippe Grieshaber
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Kerstin Boengler
- Justus Liebig University Giessen, Institute of Physiology, Giessen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
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Schaefer M, Gross W, Gebhard MM. Hearts during ischemia with or without HTK-protection analysed by dielectric spectroscopy. Physiol Meas 2018; 39:025002. [PMID: 29303486 DOI: 10.1088/1361-6579/aaa575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We investigated canine hearts during ischemia after aortic cross clamping (UI, n = 20) and after HTK-cardioplegia (HTK, n = 24) at 35 °C, 25 °C, 15 °C, and 5 °C with the aim to compare tissue changes caused by the activity of anaerobic metabolism(AAM), cell membrane destruction(CD), and gap junction uncoupling(GJU). APPROACH We measured continuously the complex dielectric spectrum(DS), ATP- and lactate content, extracellular pH, and rigor contracture. To identify changes in DS caused by AAM, CD, and GJU we performed additional experiments on the gap junction-free skeletal muscle. We used heart model simulations to calculate the effect of temperature. MAIN RESULTS AAM affected the DS at 10 MHz and we found a strong correlation between DS and the proton concentration with a maximum of DS at 10 mmol g-1 dry weight in ATP-concentration. The time of GJU was detected by a characteristic increase in DS and CD by a characteristic decrease at 13 kHz. In comparison to UI, GJU, AAM and CD were delayed by HTK and by hypothermia, indicating a minimization of energy consumption and an improved preservation of tissue structure. SIGNIFICANCE The novel findings were that in UI at 5 °C GJU occurred earlier and AAM remained constant, indicating a less effective preservation in UI by deep hypothermia in contrast to HTK.
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Affiliation(s)
- Michael Schaefer
- University Hospital Heidelberg, Section Surgical Research, INF 365, D-69120 Heidelberg, Germany
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Aass T, Chambers DJ, Haaverstad R, Grong K. Reply to Choi and Stamm. Eur J Cardiothorac Surg 2017; 51:608-609. [PMID: 27694247 DOI: 10.1093/ejcts/ezw332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Terje Aass
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - David J Chambers
- Cardiac Surgical Research, The Rayne Institute (King's College London), Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ketil Grong
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Li M, Xue L, Sun H, Xu S. Myocardial Protective Effects of L-Carnitine on Ischemia-Reperfusion Injury in Patients With Rheumatic Valvular Heart Disease Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:1485-1493. [PMID: 27569824 DOI: 10.1053/j.jvca.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The authors used L-carnitine as an ingredient in cardioplegic solution during valve replacement surgery to investigate the protective effect of L-carnitine on myocardial ischemia-reperfusion injury (MIRI) and its possible mechanism. DESIGN Prospective, randomized study. SETTING A tertiary-care hospital. PARTICIPANTS The study comprised 90 patients undergoing valve replacement under cardiopulmonary bypass. INTERVENTIONS Patients were divided randomly into 3 groups. L-carnitine was added to the crystalloid cardioplegic solution for experimental group 1 (3 g/L) and experimental group 2 (6 g/L), whereas no L-carnitine was used in the control group. The remainder of the treatment was identical for all 3 groups. MEASUREMENTS AND MAIN RESULTS Serum was collected from each patient 1 hour before the surgery and at 2, 6, 24, and 72 hours after unclamping the aorta, and tissue samples were obtained before cardiac arrest and after unclamping the aorta. The postoperative levels of serum aspartate aminotransferase, creatine kinase, creatine kinase-MB isozyme, and lactic acid dehydrogenase and the apoptotic index were all lower in the 2 experimental groups than those in the control group. In addition, each of the aforementioned serum enzyme levels and the apoptotic index in all 3 groups significantly increased after unclamping the aorta compared with baseline levels taken before surgery. Bcl-2 expression was higher and Bax was lower in the 2 experimental groups compared with those of the control group after unclamping the aorta. However, there was no significant difference in all the postoperative indices between the 2 experimental groups. CONCLUSION L-carnitine may reduce cardiopulmonary bypass-induced myocardial apoptosis through modulating the expressions of Bcl-2 and Bax, resulting in a protective effect from MIRI.
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Affiliation(s)
- Ming Li
- Department of *Cardiovascular Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, China
| | - Li Xue
- †Department of Laboratory, The Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, China
| | - Haifeng Sun
- ‡Tumour Hospital of Shaanxi Province, Xi'an Shaanxi, China
| | - Suochun Xu
- Department of *Cardiovascular Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, China.
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Aass T, Stangeland L, Moen CA, Salminen PR, Dahle GO, Chambers DJ, Markou T, Eliassen F, Urban M, Haaverstad R, Matre K, Grong K. Myocardial function after polarizing versus depolarizing cardiac arrest with blood cardioplegia in a porcine model of cardiopulmonary bypass. Eur J Cardiothorac Surg 2016; 50:130-9. [PMID: 26843432 PMCID: PMC4913873 DOI: 10.1093/ejcts/ezv488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/11/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Potassium-based depolarizing St Thomas' Hospital cardioplegic solution No 2 administered as intermittent, oxygenated blood is considered as a gold standard for myocardial protection during cardiac surgery. However, the alternative concept of polarizing arrest may have beneficial protective effects. We hypothesize that polarized arrest with esmolol/adenosine/magnesium (St Thomas' Hospital Polarizing cardioplegic solution) in cold, intermittent oxygenated blood offers comparable myocardial protection in a clinically relevant animal model. METHODS Twenty anaesthetized young pigs, 42 ± 2 (standard deviation) kg on standardized tepid cardiopulmonary bypass (CPB) were randomized (10 per group) to depolarizing or polarizing cardiac arrest for 60 min with cardioplegia administered in the aortic root every 20 min as freshly mixed cold, intermittent, oxygenated blood. Global and local baseline and postoperative cardiac function 60, 120 and 180 min after myocardial reperfusion was evaluated with pressure–conductance catheter and strain by Tissue Doppler Imaging. Regional tissue blood flow, cleaved caspase-3 activity, GRK2 phosphorylation and mitochondrial function and ultrastructure were evaluated in myocardial tissue samples. RESULTS Left ventricular function and general haemodynamics did not differ between groups before CPB. Cardiac asystole was obtained and maintained during aortic cross-clamping. Compared with baseline, heart rate was increased and left ventricular end-systolic and end-diastolic pressures decreased in both groups after weaning. Cardiac index, systolic pressure and radial peak systolic strain did not differ between groups. Contractility, evaluated as dP/dtmax, gradually increased from 120 to 180 min after declamping in animals with polarizing cardioplegia and was significantly higher, 1871 ± 160 (standard error) mmHg/s, compared with standard potassium-based cardioplegic arrest, 1351 ± 70 mmHg/s, after 180 min of reperfusion (P = 0.008). Radial peak ejection strain rate increased and the load-independent variable preload recruitable stroke work was increased with polarizing cardioplegia after 180 min, 64 ± 3 vs 54 ± 2 mmHg (P = 0.018), indicating better preserved left ventricular contractility with polarizing cardioplegia. Phosphorylation of GRK2 in myocardial tissue did not differ between groups. Fractional cytoplasmic volume in myocytes was reduced in hearts arrested with polarizing cardioplegia, indicating reduction of cytoplasmic oedema. CONCLUSIONS Polarizing oxygenated blood cardioplegia with esmolol/adenosine/magnesium offers comparable myocardial protection and improves contractility compared with the standard potassium-based depolarizing blood cardioplegia.
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Affiliation(s)
- Terje Aass
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lodve Stangeland
- Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Pirjo-Riitta Salminen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Geir Olav Dahle
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - David J Chambers
- Cardiac Surgical Research, The Rayne Institute (King's College London), Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Thomais Markou
- Cardiac Surgical Research, The Rayne Institute (King's College London), Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Finn Eliassen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Malte Urban
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut Matre
- Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ketil Grong
- Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
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Canty DJ, Joshi P, Royse CF, McMillan J, Tayeh S, Smith JA. Transesophageal Echocardiography Guidance of Antegrade Cardioplegia Delivery for Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:1498-503. [PMID: 26142365 DOI: 10.1053/j.jvca.2015.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The initial volume of antegrade cardioplegia used to induce asystole during aortic cross-clamp still is based on empiric methods and may be excessive, potentially leading to hyperkalemia, myocardial edema, and acute left ventricular distention from aortic regurgitation. The objectives were to determine whether the volume of cardioplegia required to induce asystole is proportional to left ventricular mass, and whether the degree of left ventricular distention is proportional to the severity of aortic regurgitation. DESIGN Prospective observational study. SETTING Two tertiary university hospitals. INTERVENTIONS Transesophageal echocardiography was used to estimate left ventricular mass (prolate ellipse revolution formula), quantify aortic regurgitation, and monitor for distention during initial antegrade cardioplegia delivery. The volume of cardioplegia required for asystole was recorded. PARTICIPANTS Fifty-eight patients aged over 18 years scheduled for cardiac surgery requiring aortic cross-clamping. MEASUREMENTS AND MAIN RESULTS There was a weak correlation of left ventricular mass and antegrade cardioplegia volume required for asystole (r = 0.35, p = 0.047). The degree of left ventricular distention correlated moderately with the severity of aortic regurgitation (r = 0.55, p = 0.007) and was excessive and stopped early (aborted) in 24% of all patients, including 18% of 39 patients without aortic regurgitation. An aortic regurgitation vena contracta of 0.3 cm predicted aborted cardioplegia with modest accuracy (AUC 0.81, 0.66-0.99, p = 0.02, sensitivity 71%, specifity 81%). CONCLUSIONS Estimated left ventricular mass is not a useful predictor of the initial volume of antegrade cardioplegia required to induce asystole. However transesophageal echocardiography can predict and monitor for left ventricular distention, which is common.
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Affiliation(s)
- David J Canty
- Department of Surgery, Level 6 Center for Medical Research, University of Melbourne, Royal Parade, Parkville, Australia; Department of Anaesthesia and Perioperative Medicine; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia.
| | - Prashant Joshi
- Department of Surgery and Department of Cardiothoracic Surgery, Monash Medical Center, Clayton, Australia
| | - Colin F Royse
- Department of Surgery, Level 6 Center for Medical Research, University of Melbourne, Royal Parade, Parkville, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - James McMillan
- Perfusion Services, Unit 2, Tulip Street, Cheltenham, Australia
| | - Sara Tayeh
- Perfusion Services, Unit 2, Tulip Street, Cheltenham, Australia
| | - Julian A Smith
- Department of Surgery, Level 6 Center for Medical Research, University of Melbourne, Royal Parade, Parkville, Australia; Department of Surgery and Department of Cardiothoracic Surgery, Monash Medical Center, Clayton, Australia
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