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1.
Rev. bras. cir. cardiovasc ; 35(5): 634-643, Sept.-Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137349

ABSTRACT

Abstract Objective: To investigate the effects of Bretschneider's histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia on systemic endothelial functions. Methods: A total of 50 patients who underwent isolated coronary artery bypass surgery between March 2018 and May 2018 were randomly divided into two groups - group 1 (Bretschneider's HTK solution, n=25) and group 2 (cold blood cardioplegia, n=25). Data related to the indicators of endothelial dysfunction were recorded. Flow-mediated dilation was measured together with the assessment of the values of endothelin-1, von Willebrand factor, and asymmetric dimethylarginine to identify endothelial dysfunction. Then, the two groups were compared regarding these values. Results: The most significant result of our study was that the endothelin-1 level was significantly higher in group 2 than in group 1 (P<0.001). The value of flow-mediated dilation was found to increase to a lesser degree on the postoperative days compared to the value at the day of admission in group 1 (P=0.002 and P=0.030, respectively). Conclusion: Cardiopulmonary bypass leads to endothelial dysfunction. Our results revealed that Bretschneider's HTK solution causes less severe endothelial injury than cold blood cardioplegia.


Subject(s)
Humans , Male , Female , Cardioplegic Solutions/therapeutic use , Coronary Artery Bypass , Heart Arrest, Induced , Potassium Chloride , Procaine , Prospective Studies , Glucose , Mannitol
2.
Rev. bras. cir. cardiovasc ; 35(5): 689-696, Sept.-Oct. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1137343

ABSTRACT

Abstract Objective: Our goal was to compare the operative and postoperative effects of del Nido cardioplegia (DN group) and blood cardioplegia (BC group) performed in cardiac surgery. Methods: A total of 83 patients were included, separated into DN group and BC group. The operative and postoperative effects of the two groups were compared for the first 24 hours until extubation. The operative and postoperative complete blood count (CBC), biochemical values and clinical parameters were compared. Results: The first control activated clotting time (ACT) levels in DN group patients were lower (P=0.003) during the operation. The amount of cardioplegia in DN group were lower than that in BC group (P=0.001). The pump outflow and postoperative lactate level of DN group were lower than those of BC group (P=0.005, P=0.018, respectively), as well as the amounts of NaHCO3 (P=0.006) and KCl (P=0.001) used during the operation. The same occurred with the first monocytes (Mo) and mean corpuscular volume (MCV) levels in the postoperative intensive care unit (P=0.006, P=0.002). However, the first glucose level and the eosinophil (Eo) level were higher in DN group (P=0.011, P=0.047, respectively). Conclusion: In the operative evaluation, the amount of cardioplegia, the first ACT levels, the pump outflow lactate level and the amounts of NaHCO3 and KCl in DN group were lower. In postoperative evaluation, measured level of lactate, Mo and MCV in DN group were all lower; their glucose and Eo levels were higher.


Subject(s)
Humans , Male , Female , Cardiopulmonary Bypass , Cardiac Surgical Procedures , Postoperative Period , Cardioplegic Solutions/therapeutic use , Heart Arrest, Induced
4.
Article in English | WPRIM | ID: wpr-761837

ABSTRACT

We report the case of a female patient who underwent late reoperation following endocarditis surgery. The patient first underwent surgery at 22 years of age for endocarditis with aortic and tricuspid insufficiency. She underwent aortic root replacement with a homograft and tricuspid valve replacement with a tissue valve. Coronary artery bypass using the internal thoracic artery and ligation of the left main coronary artery were performed. Ten years later, failure of the homograft and the tricuspid valve developed. In the second operation, the patient underwent a successful Bentall operation and tricuspid valve replacement with a mechanical valve under deep hypothermia and retrograde cold cardioplegia without drainage.


Subject(s)
Allografts , Coronary Artery Bypass , Coronary Vessels , Drainage , Endocarditis , Female , Heart Arrest, Induced , Humans , Hypothermia , Ligation , Mammary Arteries , Reoperation , Tricuspid Valve
6.
Rev. bras. cir. cardiovasc ; 33(3): 211-216, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-958403

ABSTRACT

Abstract Objective: The present study aimed the functional recovery evaluation after long term of cardiac arrest induced by Custodiol (crystalloid-based) versus del Nido (blood-based) solutions, both added lidocaine and pinacidil as cardioplegic agents. Experiments were performed in isolated rat heart perfusion models. Methods: Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated. Results: At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05). Conclusion: Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model.


Subject(s)
Animals , Male , Cardioplegic Solutions/pharmacology , Myocardial Reperfusion/methods , Potassium Compounds/pharmacology , Pinacidil/pharmacology , Heart Arrest, Induced/methods , Lidocaine/pharmacology , Time Factors , Vascular Resistance/physiology , Cardioplegic Solutions/chemistry , Carrier Proteins/analysis , Blotting, Western , Rats, Wistar , Coronary Vessels/physiopathology , Glucose/pharmacology , Glucose/chemistry , Heart/drug effects , Mannitol/pharmacology , Mannitol/chemistry , Microfilament Proteins/analysis
7.
Rev. bras. cir. cardiovasc ; 32(3): 171-176, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-897903

ABSTRACT

Abstract Objective: The aim of this study was to investigate whether aortic tension estimated by palpation and cardioplegia infusion line pressure provide results equivalent to those obtained with direct aortic intraluminal pressure measurement. Methods: Sixty consecutive patients who underwent coronary artery bypass graft surgeries with extracorporeal circulation were analyzed. Sanguineous cardioplegic solution in a ratio of 4:1 was administered using a triple lumen antegrade cannula. After crossclamping, cardioplegia was infused and aortic root pressure was recorded by surgeon (A) considering the aortic tension he felt in his fingertips. At the same time, another surgeon (B) recorded his results for the same measurement. Concomitantly, the anesthesiologist recorded intraluminal pressure in the aortic root and the perfusionist recorded delta pressure in cardioplegia infusion line. None of the participants involved in these measurements was allowed to be informed about the values provided by the other examiners. Results: The Bland-Altman test showed that a considerable variation between aortic wall tension was found as measured by palpation and by intraluminal pressure, with a bias of -9.911±18.75% (95% limits of agreement: -46.7 to 26.9). No strong correlation was observed between intraluminal pressure and cardioplegia line pressure (Spearman's r=0.61, 95% confidence interval 0.5-0.7; P<0.0001). Conclusion: These findings reinforce that cardioplegia infusion should be controlled by measuring intraluminal pressure, and that palpation and cardioplegia line pressure are inaccurate methods, the latter should always be used to complement intraluminal measurement to ensure greater safety in handling the cardioplegia circuit.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aorta/physiology , Venous Pressure/physiology , Myocardial Reperfusion/methods , Coronary Artery Bypass/methods , Coronary Circulation/physiology , Heart Arrest, Induced/methods , Aorta/surgery , Palpation , Reference Values , Time Factors , Cardioplegic Solutions , Body Mass Index , Observer Variation , Prospective Studies , Reproducibility of Results , Monitoring, Intraoperative/methods , Treatment Outcome , Statistics, Nonparametric
8.
Rev. bras. cir. cardiovasc ; 32(2): 90-95, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-843475

ABSTRACT

Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Cardioplegic Solutions/administration & dosage , Heart Valve Prosthesis Implantation/methods , Heart Arrest, Induced/methods , Lidocaine/administration & dosage , Aortic Valve/surgery , Postoperative Period , Potassium Chloride/administration & dosage , Bicarbonates/administration & dosage , Calcium Chloride/administration & dosage , Sodium Chloride/administration & dosage , Prospective Studies , Treatment Outcome , Lactic Acid/blood , Troponin I/blood , Creatine Kinase/blood , Magnesium/administration & dosage , Mitral Valve/surgery
9.
Chinese Journal of Surgery ; (12): 119-124, 2016.
Article in Chinese | WPRIM | ID: wpr-349221

ABSTRACT

<p><b>OBJECTIVE</b>To assess the safety and efficacy of off-pump technique with normothemia to extend thoracoabdominal aortic aneurysm replacement compared with traditional hypothermic circulatory arrest.</p><p><b>METHODS</b>From January 2004 to December 2013, 128 consecutive patients underwent surgical repair of thoracoabdominal aortic aneurysm (type Crawford Ⅱ) in Fuwai Hospital. The mean age was (37±11) years. The patients included 74 cases (57.8%) with chronic Stanford A dissection, 34 cases (26.6%) with chronic Stanford B dissection, 20 cases (15.6%) with thoracoabdominal aortic true aneurysm. There were 71 patients who underwent hypothermic circulatory arrest surgery (cardiopulmonary bypass (CPB) group) and 57 patients who underwent off-pump surgery with normothermia (off-pump group). The clinic data was compared between the 2 groups using paired t tests and χ(2) test. Kaplan-Meier survival analysis was used for postoperative survival stays.</p><p><b>RESULTS</b>The mean CPB time in CPB group was (251 ±87) minuets and the circulatory arrest time was (45±24) minuets. Spinal cord ischemia time in the two groups was (21±12) minuets and (18±10) minuets (t=5.68, P=0.51). The operation time, ventilator time, length of ICU stay and length of hospital stay of off-pump group were shorter than CPB group ((408±114) minuets vs.(630±156) minuets, t=-7.67, P=0.05; (18±13) hours vs. (113±89) hours, t=-3.86, P=0.00; (4±2) days vs.(10±9) days, t=-4.19, P=0.00; (15±7) days vs.(25±14) days, t=-4.47, P=0.00). The intraoperative blood loss in off-pump group and CPB group was (900±750) ml and (1 400±400) ml (t=-2.23, P=0.04). The mortality was 1.7% and 9.8% in the off-pump group and CPB groups (χ(2)=3.544, P=0.05). The cerebral complication rate in the normal temperature group was 1.7% vs. 22.6% in extracorporeal group (χ(2)=9.35, P<0.05). A total of 113 patients were followed up, with a follow-up rate of 88.2%. Duration of follow-up was (78±54) months. Five patients died during the follow-up period, including 2 who died of cerebral infarction and 3 paraplegia patients who died of infection. Eight patients had phase Ⅱ aortic arch replacement after a mean time of 6 months. The overall postoperative survival rate was 97%, 93% and 87% at 3 years, 5 years and 7 years, respectively.</p><p><b>CONCLUSION</b>Off-pump technique with normothemia was associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of extensive thoracoabdominal aortic aneurysm.</p>


Subject(s)
Adult , Aorta , General Surgery , Aortic Aneurysm, Thoracic , General Surgery , Blood Vessel Prosthesis Implantation , Methods , Cardiopulmonary Bypass , Heart Arrest, Induced , Methods , Humans , Length of Stay , Survival Rate
10.
Braz. j. med. biol. res ; 49(6): e5208, 2016. tab
Article in English | LILACS | ID: lil-781416

ABSTRACT

Cardioplegic reperfusion during a long term ischemic period interrupts cardiac surgery and also increases cellular edema due to repeated solution administration. We reviewed the clinical experiences on myocardial protection of a single perfusion with histidine-tryptophan-ketoglutarate (HTK) for high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 101 high-risk patients undergoing arterial switch operation between March 2001 and July 2012. We divided the cohort into two groups: HTK group, myocardial protection was carried out with one single perfusion with HTK solution; and St group, myocardial protection with conventional St. Thomas' crystalloid cardioplegic solution. The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, ICU stay, post-operative hospitalization time, and number of transfusions in HTK group were lower than those in St group (P<0.05). Univariate and multivariate analysis showed that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, HTK solution seems to be an effective and safe alternative to St. Thomas' solution for cardioplegic reperfusion in high-risk patients with complex congenital heart disease.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Cardioplegic Solutions/therapeutic use , Cardiopulmonary Bypass/methods , Heart Arrest, Induced/methods , Heart Defects, Congenital/surgery , Hypertension, Pulmonary/surgery , Analysis of Variance , Glucose/therapeutic use , Heart Defects, Congenital/mortality , Hypertension, Pulmonary/mortality , Isotonic Solutions/therapeutic use , Kaplan-Meier Estimate , Mannitol/therapeutic use , Perfusion/methods , Potassium Chloride/therapeutic use , Procaine/therapeutic use , Reproducibility of Results , Retrospective Studies , Risk Factors , Severity of Illness Index , Treatment Outcome
12.
Article in English | WPRIM | ID: wpr-195350

ABSTRACT

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.


Subject(s)
Aged , Female , Heart Arrest, Induced , Humans , Mitral Valve , Tricuspid Valve , Tricuspid Valve Insufficiency
13.
Article in English | WPRIM | ID: wpr-95902

ABSTRACT

BACKGROUND: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. METHODS: This retrospective study included 225 consecutive patients (mean age, 65+/-10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction or =III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p<0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. CONCLUSION: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.


Subject(s)
Aortic Valve , Aortic Valve Insufficiency , Aortic Valve Stenosis , Arrhythmias, Cardiac , Blood Pressure , Cardioplegic Solutions , Cardiopulmonary Bypass , Classification , Coronary Artery Disease , Endocarditis , Heart , Heart Arrest, Induced , Humans , Mortality , Myocardial Reperfusion Injury , Myocardium , Retrospective Studies , Tachycardia, Ventricular , Ventilators, Mechanical
14.
Rev. bras. cir. cardiovasc ; 29(3): 432-436, Jul-Sep/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-727151

ABSTRACT

A entrada de sódio e cálcio desempenham efeito chave no miócito submetido à parada cardíaca por hiperpotassemia. Eles provocam edema celular, acidose, consumo de trifosfato de adenosina e desencadeiam processo de morte celular programada. A parada cardíaca provocada por hipocalcemia mantém os níveis intracelulares de trifosfato de adenosina, melhora o rendimento diastólico e reduz o consumo de oxigênio, o que pode ser traduzido em melhor proteção do miócito às lesões provocadas pela parada cardíaca induzida.


The entry of sodium and calcium play a key effect on myocyte subjected to cardiac arrest by hyperkalemia. They cause cell swelling, acidosis, consumption of adenosine triphosphate and trigger programmed cell death. Cardiac arrest caused by hypocalcemia maintains intracellular adenosine triphosphate levels, improves diastolic performance and reduces oxygen consumption, which can be translated into better protection to myocyte injury induced by cardiac arrest.


Subject(s)
Humans , Cardioplegic Solutions , Hyperkalemia , Hypocalcemia , Heart Arrest, Induced/methods , Calcium/physiology , Cardioplegic Solutions/pharmacology , Medical Illustration , Potassium , Reproducibility of Results
15.
Salud(i)ciencia (Impresa) ; 20(5): 498-503, may.2014. tab
Article in Spanish | LILACS | ID: lil-790871

ABSTRACT

La cardioplejía es la mejor solución para obtener un campo operatorio cardíaco seco y quieto; también es el principal componente de la protección miocárdica. No hay dudas de su eficiencia en la prevención de las lesiones isquémicas miocárdicas durante el clampeo transversal aórtico, aunque hay pocos datos, si los hay, basados en la evidencia sobre la mejor calidad y cantidad de la cardioplejía que se requiere para maximizar la protección miocárdica (la cual puede ser diferente de una patología a otra). Durante años el método de referencia fue la cardioplejía cristaloide fría intermitente, pero progresivamente se implementaron algunos perfeccionamientos. El cambio de una cardioplejía cristaloide a una sanguínea y de una fría a una templada fueron probablemente las dos modificaciones principales adoptadas por un gran número de cirujanos cardíacos. Estas modificaciones se implementaron inicialmente en la cirugía en adultos y luego se aplicaron en la cirugía pediátrica. El objetivo de esta reseña fue describir la base racional de estos cambios, así como la progresión del uso de la cardioplejía sanguínea templada intermitente en las unidades pediátricas, sus ventajas y resultados. Otros factores involucrados en la protección miocárdica y las perspectivas futuras se analizan brevemente...


Subject(s)
Humans , Myocardium , Pediatrics , Coronary Occlusion , Genes , Heart Arrest, Induced , Myocardial Reperfusion
16.
Rev. bras. cir. cardiovasc ; 29(2): 156-162, Apr-Jun/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-719409

ABSTRACT

Introdução: As soluções que provocam parada cardíaca eletiva estão em constante evolução, porém, o composto ideal ainda não foi encontrado. Os autores comparam uma nova solução cardioplégica com histidina-triptofano-glutamato (Grupo 2) com histidina-triptofano-cetoglutarato (Grupo 1) em modelo de coração isolado de rato. Objetivo: Quantificar a dimensão fractal e entropia de Shannon em miócitos de rato submetidos à cardioplegia utilizando solução histidina-triptofano com glutamato em modelo experimental, considerando-se os marcadores caspase, IL-8 e Ki-67. Métodos: Vinte ratos machos de raça Wistar foram anestesiados e heparinizados. O tórax foi aberto, realizado cardiectomia e infundido 40 ml/Kg de solução cardioplégica apropriada. Os corações foram mantidos por 2 horas na mesma solução a 4ºC e, após esse período, colocados em aparato de Langendorff por 30 minutos com solução de Ringer Locke. Foram feitas análises imunohistoquímicas para caspase, IL-8 e KI-67. Resultados: A dimensão fractal e a entropia de Shannon dos corações submetidos à parada cardíaca eletiva nos grupos 1 e 2 não foram diferentes. Conclusão: A quantidade de informações avaliada pela entropia de Shannon e a distribuição das mesmas (dada pela dimensão fractal) nas lâminas de coração de rato submetidas à cardioplegia com solução histidina-triptofano-acetoglutarato ou histidina-triptofano-glutamato não foram diferentes, o que mostra que a solução de histidina-triptofano-glutamato é tão boa quanto a histidina-triptofano-cetoglutarato na preservação dos miócitos em modelo de coração isolado de rato. .


Introduction: Solutions that cause elective cardiac arrest are constantly evolving, but the ideal compound has not yet been found. The authors compare a new cardioplegic solution with histidine-tryptophan-glutamate (Group 2) and other one with histidine-tryptophan-cetoglutarate (Group 1) in a model of isolated rat heart. Objective: To quantify the fractal dimension and Shannon entropy in rat myocytes subjected to cardioplegia solution using histidine-tryptophan with glutamate in an experimental model, considering the caspase markers, IL-8 and KI-67. Methods: Twenty male Wistar rats were anesthetized and heparinized. The chest was opened, the heart was withdrawn and 40 ml/kg of cardioplegia (with histidine-tryptophan-cetoglutarate or histidine-tryptophan-glutamate solution) was infused. The hearts were kept for 2 hours at 4ºC in the same solution, and thereafter placed in the Langendorff apparatus for 30 min with Ringer-Locke solution. Analyzes were performed for immunohistochemical caspase, IL-8 and KI-67. Results: The fractal dimension and Shannon entropy were not different between groups histidine-tryptophan-glutamate and histidine-tryptophan-acetoglutarate. Conclusion: The amount of information measured by Shannon entropy and the distribution thereof (given by fractal dimension) of the slices treated with histidine-tryptophan-cetoglutarate and histidine-tryptophan-glutamate were not different, showing that the histidine-tryptophan-glutamate solution is as good as histidine-tryptophan-acetoglutarate to preserve myocytes in isolated rat heart. .


Subject(s)
Animals , Male , Cardioplegic Solutions/pharmacology , Glutamic Acid/pharmacology , Heart Arrest, Induced/methods , Myocytes, Cardiac/drug effects , Caspases/analysis , Disease Models, Animal , Entropy , Fractals , Glucose/pharmacology , Heart/drug effects , Immunohistochemistry , /analysis , /analysis , Mannitol/pharmacology , Potassium Chloride/pharmacology , Procaine/pharmacology , Rats, Wistar , Reproducibility of Results , Time Factors
17.
Rev. bras. cir. cardiovasc ; 29(2): 229-235, Apr-Jun/2014. tab, graf
Article in Portuguese | LILACS | ID: lil-719410

ABSTRACT

INTRODUÇÃO: O método mais comumente utilizado para a proteção miocárdica é o de administrar-se solução cardioplégica na circulação coronária. Entretanto, a proteção pode ser alcançada através da perfusão intermitente do sistema coronariano com sangue do próprio paciente, que é realizada por meio de múltiplas sequências de pinçamento e abertura do clamp aórtico ou por meio do pinçamento único e canulação acessória da raiz aórtica. Objetivo: Avaliar o desfecho clínico e a ocorrência de eventos neurológicos no período intra-hospitalar dos pacientes submetidos à cirurgia de revascularização do miocárdio com a técnica proposta aqui neste estudo. Métodos: Descreve-se uma técnica de proteção miocárdica no uso do pinçamento único de aorta que consiste na canulação acessória da raiz aórtica com sistema aperfeiçoado para perfusão coronária intermitente, foi realizado estudo observacional transversal prospectivo onde foram estudados 50 pacientes (idade média 58,5±7.19 anos) submetidos à cirurgia de revascularização do miocárdio sob a técnica proposta. Foram avaliadas variáveis clínicas e laboratoriais pré e pós-operatórias. Resultados: O nível médio de pico da CKMB pós-operatória foi de 51,64±27,10 U/L no segundo pós-operatório e da troponina I foi de 3,35±4,39 ng/ml no quarto pós-operatório, e estiveram dentro do limite da normalidade. Não foi observado nenhum óbito e um paciente evoluiu com alteração neurológica leve. A monitorização hemodinâmica não revelou alterações. Conclusão: A cirurgia de rev...


Introduction: The most common method used for myocardial protection is administering cardioplegic solution in the coronary circulation. Nevertheless, protection may be achieved by intermittent perfusion of the coronary system with patient's own blood. The intermittent perfusion may be performed by multiple sequences of clamping and opening of the aortic clamp or due single clamping and accessory cannulation of the aortic root as in the improved technique proposed in this study, reperfusion without the need for multiple clamping of the aorta. Objective: To evaluate the clinical outcome and the occurrence of neurological events in in-hospital patients submitted to myocardial revascularization surgery with the "improved technique" of intermittent perfusion of the aortic root with single clamping. Methods: This is a prospective, cross-sectional, observational study that describes a myocardial management technique that consists of intermittent perfusion of the aortic root with single clamping in which 50 patients (mean age 58.5±7.19 years old) have been submitted to the myocardial revasculrization surgery under the proposed technique. Clinical and laboratory variables, pre- and post-surgery, have been assessed. Results: The mean peak level of post-surgery CKMB was 51.64±27.10 U/L in the second post-surgery and of troponin I was 3.35±4.39 ng/ml in the fourth post-surgery, within normal limits. No deaths have occurred and one patient presented mild neurological disorder. Hemodynamic monitoring has not indicated any changes. Conclusion: The myocardial revascularization surgery by perfusion with the improved technique with intermittent aortic root with single clamping proved to be safe, enabling satisfactory clinical results. .


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Aorta/surgery , Coronary Artery Bypass/methods , Heart Arrest, Induced/methods , Internal Mammary-Coronary Artery Anastomosis/methods , Ischemic Preconditioning, Myocardial/methods , Constriction , Coronary Circulation , Cross-Sectional Studies , Cardioplegic Solutions/administration & dosage , Medical Illustration , Prospective Studies , Reproducibility of Results , Risk Factors , Time Factors , Treatment Outcome
18.
Ann Card Anaesth ; 2014 Jan; 17(1): 33-39
Article in English | IMSEAR | ID: sea-149689

ABSTRACT

Cardiac surgery carried out on cardiopulmonary bypass (CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non‑pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero‑placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre‑operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.


Subject(s)
Adult , Anesthetics , Cardiac Surgical Procedures , Cardiopulmonary Bypass/methods , Extracorporeal Circulation , Female , Heart Rate, Fetal/physiology , Gestational Age , Heart Arrest, Induced , Heart Valve Prosthesis Implantation , Humans , Monitoring, Intraoperative/methods , Placenta/blood , Pregnancy/physiology , Pregnancy Outcome , Uterus/blood , Uterus/physiology
19.
Professional Medical Journal-Quarterly [The]. 2014; 21 (5): 987-991
in English | IMEMR | ID: emr-153939

ABSTRACT

Intermittent antegrade warm blood cardioplegia is routinely used as a mean of myocardial protection since its introduction. There is a considerable debate on the longest time off cardioplegia interval during aortic cross clamping. To see the frequency and extent of myocardial damage in patients undergoing CABG receiving intermittent antegrade warm blood Cardioplegia at LTOC [longest time off cardioplegia] 11-15 minutes [Group I] and 16-20 minutes [Group II]. A randomized prospective study involving 94 patients was arranged to see the safe periods of intermittency. There were two groups of patients having LTOC of 11-15 minutes [Group I] and 16-20 minutes [Group II]. 20 minutes was the upper limit. The duration of study was from 1-09-2013 to 10-02-2014. Data was analyzed using SPSS Version 16. Independent sample t-test and chi-square were applied to see the significance. Mean age was 54.1 +/- 9.36 years. There were more males as compared to females. More than 50% of the patients had Hypertension and Diabetes. There was no urgent surgery. Triple vessel disease [TVD] was present in 48.9% patients and 40.4% had Double vessel disease [DVD]. Average blood flow during CPB was 2.4 +/- 0.14 [L/ min.m-2]. Average body temperatures were 31.7 +/- 2.30 C. Cardioplegia temperature was 36-370 C. According to Left Ventricular Function Classification, 43.6% of the patients were of LV grade II and 10.6% of LV grade III. There was no significant increase in the levels of CK-MB in two groups. 77.8% patient in Group I and 66.7% in Group II gained spontaneous rhythm [p-value 0.16]. IABP was inserted in 5.4% patients in group I and 5.6% in group II [p-value 0.97]. There was no failure to wean off from bypass and no peri-operative mortality. The levels of inotropes viz dopamine and epinephrine on weaning were also almost the same. Perioperative MI occurred only in 7 patients [ruled out by biochemical evidence]. A reasonable margin of safety exists with intermittent antegrade warm blood cardioplegia in these two groups. So the LTOC [longest time off cardioplegia] up to 20 minutes is unlikely to lead to adverse clinical outcomes and is clinically acceptable


Subject(s)
Humans , Male , Female , Coronary Artery Bypass/methods , Heart Arrest, Induced , Myocardial Infarction/surgery , Intra-Aortic Balloon Pumping , Prospective Studies , Coronary Artery Bypass/adverse effects
20.
Article in English | WPRIM | ID: wpr-215834

ABSTRACT

BACKGROUND: As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). METHODS: Consecutive 314 patients (mean age, 62.5+/-10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels > or =10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value. RESULTS: There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049). CONCLUSION: PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.


Subject(s)
Aortic Valve Stenosis , Aortic Valve , Arrhythmias, Cardiac , Cardiac Output, Low , Creatinine , Heart Arrest, Induced , Heart Ventricles , Humans , Ischemia , Myocardial Reperfusion Injury , Myocardium , Phosphotransferases , Risk Factors , Stroke Volume , Troponin I
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