Cardiopulmonary Bypass Surgery?Cold Alert!

The term 揷old agglutinin (CA)� refers to a group of disorders caused by anti?erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4癈�癈). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.

Desarrollo histórico de la protección miocárdica: el gran salto adelante de la cirugía cardiovascular / Historical development of myocardial protection: the big jump ahead of cardiovascular surgery

La cirugía a "corazón abierto" con circulación extracorpórea se apronta a cumplir 70 años. Desde un comienzo se hizo necesario buscar la forma de tener un campo operatorio quieto y exangüe, sin riesgo de embolia aérea, lo que llevó al desarrollo de la primera "cardioplegía" por Melrose, a fines de los años 1950's. Sin embargo, esta cayó en descrédito rápidamente y fue abandonada en años 1960's. Se necesitó que transcurrieran casi 15 años para el retorno de la cardioplegía, ahora como forma de proteger al corazón de la isquemia. Durante este periodo se volvió a la fibrilación ventricular a la perfusión coronaria, al paro isquémico y a la hipotermia tópica. Sin embargo, algunos investigadores mantuvieron su interés en la cardioplegía, facilitando el retorno clínico de esta con Hearse en 1976, con la solución cardioplégica cristaloide del Hospital St. Thomas, la que se asentó como el principal método de protección miocárdica, hasta la irrupción de Buckberg con su cardioplegía sanguínea en multidosis, la que se convirtió, a comienzo de los años 1990's, en el procedimiento preferido para proteger al corazón durante el periodo de isquemia requerido para operar en él, infundida ahora no solo por vía anterógrada, sino que también por vía retrógrada. Esto, hasta Pedro Del Nido y su vuelta a la dosis única, solo por vía anterógrada.

Open heart surgery with extracorporeal circulation is approaching its 70th anniversary. From the beginning it was necessary to find a way to have a still and bloodless operative field, without the risk of air embolism, which led to the development of the first "cardioplegía" by Melrose, at the end of the 1950's. However, it quickly fell into disrepute and was abandoned in the 1960's. It took almost 15 years for cardioplegía to return, now as a way of protecting the heart from ischemia. During this period, ventricular fibrillation, coronary perfusion, ischemic arrest and topical hypothermia returned. However, some investigators maintained their interest in cardioplegía, facilitating the clinical return of cardioplegía with Hearse in 1976, with the crystalloid cardioplegic solution of St. Thomas's Hospital. This became the main method of myocardial protection until the irruption of Buckberg with his multidose blood cardioplegía, which became, at the beginning of the 90's, the preferred method to protect the heart during the ischemic period required to operate on it, now infused not only by anterograde route but also by retrograde route. This, until Pedro Del Nido and his return to the single dose, only via the antegrade route.

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A Propensity-Matched Analysis

Abstract Introduction: Del Nido cardioplegia was reported to provide adequate myocardial protection and clinical outcomes with improved surgical flow in adult cardiac surgical procedures. And many clinicians have already modified the traditional formula. This study aims to investigate the efficacy and safety of tepid modified del Nido cardioplegia compared to cold blood cardioplegia in adult patients undergoing cardiac surgery. Methods: This retrospective study included one hundred consecutive adult patients undergoing cardiac surgical procedures using tepid modified del Nido cardioplegia. One hundred consecutive adult patients undergoing cardiac surgical procedures with cold blood cardioplegia were the control group. Propensity score matching yielded 89 modified del Nido and 89 cold blood cardioplegia patients. Results: There were no significant differences when comparing the two matched groups regarding the requirement for intraoperative defibrillation (P=0.36), postoperative peak troponin T levels (0.18), perioperative inotropic support (P=0.26), intra-aortic balloon pump requirement (P=0.62), and postoperative left ventricular ejection fraction at discharge (P=0.4) and on the sixth postoperative month (P=0.37). Mean cross-clamping time (P=0.005), cardiopulmonary bypass time (P=0.03), and total operation time (P=0.03) were significantly shorter in the del Nido group. Conclusion: Tepid modified del Nido cardioplegia may be a safe alternative to cold blood cardioplegia in adult patients undergoing cardiac surgical procedures.

Clinical Outcomes of Del Nido Cardioplegia and St Thomas Blood Cardioplegia in Neonatal congenital Heart Surgery

Objectives:Cardioplegia is essential for adequate myocardial protection. There continues to remain ambiguity regarding the ideal cardioplegia for adequate myocardial protection in congenital heart surgery. This study compares clinical outcomes using St Thomas II solution and Del Nido cardioplegia in neonates undergoing cardiac surgery. Methods: All neonates (<30 days) from 2011 to 2017 who underwent surgery requiring cardioplegic arrest were analyzed retrospectively. We divided the cohort into two groups depending on cardioplegia received, as group A (Blood cardioplegia with St Thomas II solution, n = 56) and group B (Del Nido cardioplegia, n = 48). Various demographic, intraoperative, early postoperative, and discharge variables were analyzed. Results: Two groups were similar in age, gender, pre?operative diagnosis, and risk category. Cardiopulmonary bypass (CPB) time (P = 0.002), aortic cross?clamp (ACC) time (P = 0.018), and the number of doses of cardioplegia (P < 0.001) were significantly lower with Del Nido group. Though vasoactive inotropic score (VIS) (P = 0.036) was high during the first 24 h in the immediate postoperative period in group A, there was no difference in early mortality among both groups (P = 0.749). Both groups did not show significant differences related to various postoperative and discharge variables. Conclusion: When compared to St. Thomas solution, the use of Del Nido cardioplegia solution in neonates is associated with a significant decrease in CPB and ACC times and VIS in the first 24 h after surgery. The choice of cardioplegia (St Thomas/Del Nido) in neonates does not affect early mortality and early postoperative clinical outcomes.

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

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

Myocardial protection using del Nido cardioplegia solution in severe valvular surgery / 中国医师杂志

Objective:To discuss the safety and effectiveness of del Nido cardioplegia solution in severe valvular surgery.Methods:A retrospective analysis of 138 patients of severe valvular disease underwent valve replacement or valvuloplasty in Hunan Provincial People′s Hospital between July 2019 and December 2020 was performed. According to the different cardioplegic solution used, patients were separated in two groups: the del Nido cardioplegia group (D group, n=73) and the St. Thomas cardioplegia group (C group, n=65). The perioperative clinical results of the two groups were compared to evaluate the safety and effectiveness of del Nido cardioplegia in the operation of severe valvular disease. Results:Preoperative characteristics were similar between the two groups, including gender, age, body weight, ejection fraction, and myocardial markers ( P>0.05). No statistical differences were noted in cardiopulmonary bypass time, clamp time, mechanical ventilation time, vasoactive drug use time, ICU and hospital stay time, and ejection fraction before discharge ( P>0.05). However, the times of cardioplegia perfusion [(1.33±0.47)times vs (4.08±0.48)times] and the total perfusion time [(3.96±1.41)min vs (13.15±1.46)min] in group D were lower than those in group C, while the automatic rebound rate (90.41% vs 76.92%) was higher than that in group C ( P<0.05). Both groups successfully completed the operation. There were no serious complications of important organs such as low cardiac output, brain, liver and kidney during and after the operation. There were no deaths during hospitalization, and all patients were cured and discharged. Conclusions:There was no significant difference in myocardial protection between del Nido and St. Thomas cardioplegia solution in severe valvular surgery. The application of del Nido cardioplegia could reduce the frequency of perfusions and total perfusion time.

Forensic Progress on Death Following Carotid Sinus Inhibition / 法医学杂志

Death after carotid sinus trauma is usually attributed to death from inhibition, a type of sudden death. Currently, the number of incidents is scarce, and related studies are few. Therefore, how to determine the involvement of carotid sinus and determine the role of diseases in the cause of death has always been a difficult point in forensic investigation. This article sorts out the research literature on carotid sinus related death at home and abroad in recent years, systematically reviews the anatomic structure of the carotid sinus nerve, the clinical epidemiology of carotid sinus syndrome, and the research on the death mechanism of carotid sinus injury at home and abroad in recent years, in order to provide references for forensic pathology research and prosecution.

Primera experiencia argentina de cardioplegía de Del Nido en adultos. Trabajo comparativo con cardioplegía de Buckberg / First Argentine Experience with Del Nido Cardioplegia in Adults. Comparison with Buckberg Cardioplegia

RESUMEN Introducción: Tradicionalmente, en las intervenciones cardiovasculares de pacientes adultos que requieren de circulación extracorpórea, se utiliza la solución cardioplégica de Buckberg, mientras que en cirugía cardíaca infantil se emplea con mayor frecuencia la solución de Del Nido. Este es el primer reporte argentino de la experiencia con esta última cardioplegía en pacientes adultos. Material y métodos: Desde noviembre de 2016 hasta marzo de 2018, el mismo equipo quirúrgico realizó 267 cirugías cardíacas en dos centros de cirugía cardiovascular; de ese total, a 50 pacientes se les realizó la cardioplegía de Del Nido (grupo DN) y se los comparó con un grupo homogéneo de 50 pacientes que recibieron cardioplegía de Buckberg (grupo BK). Resultados: En promedio, el tiempo total de cirugía, de circulación extracorpórea y de clampeo aórtico fueron, respectivamente, 126,70 min, 70,63 min y 54 min en el grupo DN y 165,78 min, 80,5 min y 64,21 min en el grupo BK; estas diferencias fueron estadísticamente significativas (p = 0,001, p = 0,0032 y p = 0,0004, respectivamente). Las comorbilidades y el tipo de cirugía valvular realizada fueron similares en ambos grupos. Conclusión: La cardioplegía de Del Nido puede utilizarse en pacientes adultos con excelentes resultados; esta permite disminuir significativamente los tiempos de cirugía, clampeo aórtico y circulación extracorpórea, con todos los beneficios que esto conlleva.

ABSTRACT Background: Traditionally, Buckberg cardioplegic solution is used for cardiovascular interventions in adult patients requiring cardiopulmonary bypass, whereas Del Nido solution is more commonly used in pediatric cardiac surgery. This is the first Argentine report of Del Nido cardioplegia in adult patients. Methods: From November 2016 to March 2018, 267 cardiac surgeries were performed by the same surgical team in two cardiovascular surgery centers. Among the total number of patients undergoing these surgeries, 50 received Del Nido cardioplegia (DN group) and were compared with a homogeneous group of 50 patients receiving Buckberg cardioplegia (BK group). Results: Average total operative, cardiopulmonary bypass and aortic cross-clamp times (128.80 min, 70.83 min and 55 min, respectively, in the DN group, and 167.78 min, 80.7 min and 64.71min, in the BK group) were statistically significant between groups (p=0.001, p=0.0032 and p=0.0004, respectively). Comorbidities and type of valve surgery were similar in both groups Conclusions: Del Nido cardioplegia can be used in adult patients with excellent results, allowing to significantly shorten operative, aortic cross-clamp and cardiopulmonary bypass times, with all the benefits these lower times entail.

Comparative analysis of myocardial protection with htk solution and hypothermic hyperkalemic blood solution in the correction of acyanogenic congenital cardiopathies - a randomized study

Abstract Objective: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. Methods: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. Results: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. Conclusion: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.

A Survey of the Cardioplegia Methods Targeting Under 40 Cardiovascular Surgeons No.9 / 日本心臓血管外科学会雑誌

Cardiovascular surgeons, generally have many strong preferences regarding basic surgical skills. However, those basic skills have not been discussed great detail. The aim of this study is to survey the cardioplegia methods targeting cardiovascular surgeons in Japan aged Under 40, and to share the results of those basic skills.

Intra-Operative Hemodilution During Mitral Valve Replacement Surgery Using St Thomas Vs Del Nido Cardioplegia- A Single Centre Study.

Aim To assess the hemodilution during mitral valve surgery performed using St Thomas cardioplegia versus Del Nido cardioplegia. We also compared the volume of cardioplegia required, cross clamp time and cardiopulmonary bypass (CPB) time in each group. Methods and Materials Patients admitted between the period of January 2015 to June 2018 for mitral valve disease were included in this retrospective study. Patients were divided into two groups each comprising of 50 patients according to type of cardioplegia received during surgery. Results The hemodilution was much lesser in the patients who underwent mitral valve surgery using St Thomas cardioplegia (Haematocrit 26.3 ± 2.5%) as compared to those patients underwent the same surgery using del Nido Cardioplegia (Haematocrit 24.8 ± 2.2%). The volume of cardioplegia, cross clamp time and cardiopulmonary bypass time was less with del Nido cardioplegia as compared to St. Thomas cardioplegia (922.6 ± 95.4 vs 1854 ± 228.1 ml; 65.5 ± 8.2 vs 71.52 ± 8.8 minutes and 99.3 ± 13.1 vs 110.6 ± 14.6 minutes respectively). Conclusion The use of St Thomas Cardioplegia in patients during mitral valve replacement surgery has less hemodilution on CPB as compared to del Nido cardioplegia. But the patients who received del Nido cardioplegia has less requirement of number and volume of cardioplegia required during surgery with shorter cross clamp and CPB time

Modified Del Nido cardioplegia versus St.Thomas cardioplegia for myocardial protection in adult patients with combined valve replacement / 中国胸心血管外科临床杂志

@#Objective     To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods     From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results     There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed  combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39 vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion     Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.

Application of Del Nido cardioplegia in adult valve surgery: A case control study / 中国胸心血管外科临床杂志

@#Objective    To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods    We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactiveinotropic score at postoperative 24 hours (VIS 24) were recorded. Results    No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponinI and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion    Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduces hemodilution and perioperative blood transfusion.

The myocardium protection of the joint application of adenosine and cold-blood cardioplegia containing potassium in coronary artery bypass grafting / 天津医药

One hundred patients underwent coronary artery bypass grafting and thirty patients underwent replacement of mitral valve were included in this study, and patients were randomized to two groups. Adenosine group (group I):6 mg adenosine was diluted with physiological saline and injected from the root of the ascending aorta after blocking it. The aorta was then perfused with high-potassium cold-blood cardioplegia. Control group (group II):the aorta was just perfused with high-potassium cold-blood cardioplegia. Adenosine was only added in first perfusion in adenosine group. Both groups were reperfused half-amount of cold-blood cardioplegia containing potassium every 30 minutes. Relevant clinical indexes and myocardial enzymological determination were compared between two groups. Results For patients who underwent CABG, the cardiac arrest induced time,ICU dwell and assisted ventilation time after surgery and dopamine usage were all less in adenosine group than those of control group (P 0.05). For patients who underwent MVR, the cardiac arrest induced time and dopamine usage were all less in adenosine group than those of control group (P0.05). For both operations, 4 hours after clamping aorta, creatine kinase isoenzyme (CK-MB) was less in adenosine group than that of control group (P<0.01 or P<0.05), and 4 hours and 24 hours after bypass, cardiac troponin I (cTnI) was significantly higher in control group than that of adenosine group (P < 0.05). Conclusion After aorta is clamped, immediate injection of adenosine diluent and cold-blood cardioplegia containing potassium from the root of the ascending aorta can lead to quick heart arrest, reduce the release of myocardial enzymes and dosage of vasoactive agents, and shorten ICU dwell and assisted ventilation time.

Mechanisms of oxidative stress and myocardial protection during open‑heart surgery.

Cold heart protection via cardioplegia administration, limits the amount of oxygen demand. Systemic normothermia with warm cardioplegia was introduced due to the abundance of detrimental effects of hypothermia. A temperature of 32–33°C in combination with tepid blood cardioplegia of the same temperature appears to be protective enough for both; heart and brain. Reduction of nitric oxide (NO) concentration is in part responsible for myocardial injury after the cardioplegic cardiac arrest. Restoration of NO balance with exogenous NO supplementation has been shown useful to prevent inflammation and apoptosis. In this article, we discuss the “deleterious” effects of the oxidative stress of the extracorporeal circulation and the up‑to‑date theories of “ideal’’ myocardial protection.

"""No Touch"" ostial cardioplegia delivery for aortic valve replacement" / 中华胸心血管外科杂志

Objective To summary and explore the indications,safety and effectiveness of no touch ostial cardioplegia delivery method during aortic valve replacement(AVR) for severe aortic insufficiency(AI),in order to provide guidance for clinical application.Methods Between September 2012 and February 2015,63 cases were randomly divided into two groups,in study group we used this technique in 31 patients with a mean age of(58.0 ± 15.0) years and a range of 31 to 74 years old.The degree of AI averaged (3.5 ± 0.5) according to a semiquantitative 5-grade scale[1].32 patients were enrolled in control group with a mean age of(60.4 ± 9.4) years and a range of 22 to 73 years old.The degree of AI averaged (3.6 ± 0.5).The abnormal aortic cusps were sutured though the aortic incision,which would be closed temporarily.Blood cardioplegia was infused repeatedly into the coronary osita through the closed aortic incision during the remainder of the procedure except AVR,when the closed aortic incision was reopened.Results In the study group,spontaneous resumption of nodal and normal sinus rhythm shortly after the removal of aortic cross-clamp was achieved in all patients,no hearts had to be electrically defibrillated and electrocardiogram showed no obvious S-T segment elevation.The time from cross-clamp removal to sinus rhythm was(12.3 ± 7.7) minutes in the study group,versus (18.6 ± 8.2) minutes in the control group(P =0.037).No operative mortality occurred in both groups.There was a significant increase in left ventricular ejection fraction[from(0.54 ± 0.09) preoperatively to(0.62 ± 0.06) postoperatively] (P =0.005) in patients of the study group,which was not seen in patients of the control group.Conclusion Preliminary results have shown that the no touch ostial cardioplegia delivery method is a feasible method for cardioplegia infusion during aortic valve replacement in patients with severe AI.

Current Status and Future Perspectives of Cardioplegic Protection in Cardiac Surgery, Highlighting the Mechanisms of Targeted Cellular Components / 日本心臓血管外科学会雑誌

“Depolarized arrest”, induced by hyperkalemic (moderately increased extracellular potassium) cardioplegia is the gold standard to achieve elective temporary cardiac arrest in cardiac surgery. Hyperkalemic cardioplegic solutions provide good myocardial protection, which is relatively safe, and easily and rapidly reversible. However, this technique has detrimental effects associated with ionic imbalance involving sodium and calcium overload of the cardiac cell induced by depolarization of the cell membrane. Hence, the development of an improved cardioplegic solution that enhances myocardial protection is anticipated as an alternative to hyperkalemic cardioplegia. In this review, we assess the suitability and clinical potential of cardioplegic agents to induce “non-depolarized arrest” from the viewpoint of rapid cardiac arrest, myocardial protection, reversibility, and toxicity. “Magnesium cardioplegia” and “esmolol cardioplegia” have been shown to exert superior protection with comparable safety profiles to that of hyperkalemic cardioplegia. These alternative techniques require further examination and investigation to challenge the traditional view that hyperkalemic arrest is best. Endogenous cardioprotective strategies, termed “ischemic preconditioning” and “ischemic postconditioning”, may have a role in cardiac surgery to provide additional protection. The elective nature of cardiac surgery, with the known onset of ischemia and reperfusion, lends it to the potential of these strategies. However, the benefit of preconditioning and postconditioning during cardiac surgery is controversial, particularly in the context of cardioplegia. The clinical application of these strategies is unlikely to become routine during cardiac surgery because of the necessity for repeated aortic crossclamping with consequent potential for embolic events, but offers considerable potential especially if “pharmacological” preconditioning and postconditioning could be established.

Effect of Cold Self-blood Cardioplegia With Ulinastatin on Immature Myocardial Cell Apoptosis in Infant Patients / 中国循环杂志

Objective: To investigate the effect of cold self-blood cardioplegia with ulinastatin on immature myocardial cell apoptosis and protein expressions of Bcl-2, Bax in ventricular septal defect (VSD) infants. Methods: A total of 60 infants received VSD repairing operation with cardiopulmonary bypass (CPB) in our hospital were summarized. The patients were randomly divided into 2 groups:Test group, the infants received cold self-blood cardioplegia with ulinastatin when aortic cross-clamp was closed. Control group, the infants received cold self-blood cardioplegia when aortic cross-clamp was closed. n=30 in each group. The right atrium tissue was collected before CPB and 10 min after releasing aortic cross-clamp. The index of myocardial cell apoptosis was observed by TUNEL method, and the protein expressions of Bcl-2, Bax were examined by immunohistological method. Results: Both groups showed the higher index of myocardial cell apoptosis at 10 min after releasing aortic cross-clamp than 5 min before CPB, and the apoptosis index in Test group was lower than that in Control group, all P Conclusion: Cold self-blood cardioplegia with ulinastatin could protect immature myocardum from ischemia-reperfusion injury in VSD infants during CPB operation in clinical practice.

Effect of cold autologous blood cardioplegia on superoxide dismutase and matrix metalloproteinase-2 levels of infant immature myocardium / 中国综合临床

Objective To investigate the effect of cold autologous blood cardioplegia and HTK solution on changes of superoxide dismutase (SOD) and Matrix metalloproteinase-2 (MMP-2) in infant coronary sinus vein blood,which underwent ventricular septal defect suture in extracorporeal circulation,in order to reveal their protective effect of autologous cold blood cardioplegia on immature myocardium.Methods Sixty cases with ventricular septal defect,aged less 1-year-old,were randomly divided into experimental group (n =30) and control group(n =30).Autologous cold blood cardioplegia was obtained on aortic blood before aortic root draw in extracorporeal circulation with K + concentration of 20 mmol/L and 4 ℃ temperature.The experimental group was used cold autologous blood cardioplegia as arresting and protecting cardioplegia,while the control group used HTK solution.Blood sample from coronary sinus and vein was obtained at immediately before aortic cross-clamping,1 minute and 15 minutes after aortic cross-opening.SOD and MMP-2 levels were determined by enzyme-Linked Immuno Sorbent Assay (ELISA).Results The levels of SOD and MMP-2 levels within the group,between the groups and interaction were significant difference (P ＜ 0.05).After aortic cross-opening,the level of SOD and MMP-2 of the experimental group and the control group were increased (P ＜ 0.05).Before aortic cross-clamping,The activity of SOD in experiment was(85.37 ± 16.82) mU/L,as same as that in the control group((91.51 ± 15.02) mU/L,P ＞ 0.05).The MMP-2 concentration was in experiment group was (362.29 ±29.52) μg/L,as same as that in the control group((372.32 ± 31.42) μg/L,P ＞ 0.05).At 1 minute after aortic cross-opening,there were significant differences regarding of SOD and MMP-2 levels between the both groups(SOD ∶ (106.97 ± 17.46) mU/L vs.(98.74 12.54) mU/L,P ＜ 0.05 ; MMP-2 ∶ (439.48 ± 51.62) μg/L vs.(465.49 ±48.83) μg/L,P ＜0.05) ;The same trend was seen at 15 minutes after aortic cross-opening in two groups in terms of SOD and MMP-2 level (SOD:(104.03 ± 12.63) mU/L vs.(97.94 10.87) mU/L,P ＜0.05; MMP-2:(390.16 ±45.63) μg/L vs.(425.21 ±48.24) μg/L,P ＜0.05).Compare to group B,arrhythmia incidence(x2 =8.223,P ＜ 0.05) and positive inotropic drug dependent degree was lower in group A (x2 =4.022,P ＜ 0.05).Conclusion The cold autologous blood cardioplegia could promote the release of SOD in immature myocardium and reduce the production of MMP-2,which has endogenous protective effect for the infant Imature myocardium.

Study of enzyme function on blood crystalloid cardioplegia at different flow continuous perfusion / 中国医师进修杂志

Objective To investigate the effects of different flow volume of continuous 1:1 blood crystalloid cardioplegia on open heart surgery.Methods Retrospective randomized study was performed on 80 patients undergoing valve replacement and congenital heart disease with 1:1 blood crystalloid cardioplegia by minimum-flow continuous perfusion[0.5ml/(kg·min),group A,40 cases],high-flow continuous perfusion[(2.0 ml/(kg·min),group B,40 cases).The changes of creatine kinase(CK),isoenzyme of creatine kinase(CK-MB),lactate dehydrogenase(LDH),lactic dehydrogenase isoenzyme(LDH_1)were detected before operation and at 6,12,24,48,72 h after operation.Results The cardioplegia liquid was (41.72±7.98)ml/kg in group A,(142.09±9.65)ml/kg in group B,there was significant difference between two groups(P<0.05).During the first 72 h postoperative the value of CK,CK-MB,LDH and LDH1 in two groups were increased to different degree,serum enzymes levd increased significantly between 12,24 h after operation(P<0.05)and return to normal at 72h after operation in two groups.Butbetween two groups there was no significant difference(P＞0.05).ConclusionMinimum-flow continuous perfusion of 1:1 blood crystalloid cardioplegia appears to be superior in safety,decrease of myocardial enzymes integrity.