Normokalemic nondepolarizing long-acting blood cardioplegia. (October 2017)

• Record Type: Journal Article
• Authors: Malhotra, Amber; Wadhawa, Vivek; Ramani, Jaydip; Garg, Pankaj; Sharma, Pranav; Pandya, Himani; Rodricks, Dayesh; Tavar, Reema
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 25:Number 7/8(2017)
• Page Start: 495
• Page End: 501
• Publication Date: 2017-10
• Subjects: Cardioplegic solutions -- Creatine kinase -- Heart arrest -- induced -- Herat vale diseases -- Lidocaine -- Troponin I; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492317736448
• Languages: English
• ISSNs: 0218-4923

Abstract

Objective: Blood cardioplegia, the gold-standard cardioprotective strategy, requires frequent dosing, resulting in hyperkalemia-induced myocardial edema. The aim of our study was to compare the efficacy and safety of a long-acting blood-based cardioplegia with physiological potassium levels versus the well-established cold blood St. Thomas' Hospital no. 1 cardioplegia solution in multivalve surgeries. Methods: One hundred patients undergoing simultaneous elective aortic and mitral valve replacement ± tricuspid valve repair were randomized in two groups. In group 1, adenosine 12 mg was given via the aortic root after crossclamping, followed by a single dose of long-acting solution at 14℃ (30 mLċkg −1 ); in group 2, an initial 30 mLċkg −1 of St. Thomas' cardioplegia at 14℃ was administered, followed by 15 mLċkg −1 every 20 min. Duration of cardiopulmonary bypass, inotropic score, arrhythmias, ventilation time, and the levels of interleukin-6, creatinine kinase-MB, and troponin I were compared. Results: Mean cardiopulmonary bypass and crossclamp times were 134.04 ± 36.12 vs. 154.34 ± 34.26 ( p = 0.004) and 110.37 ± 24.80 vs. 132.48 ± 31.68 min ( p = 0.002), respectively, in the long-acting and St. Thomas' groups. Cardiac index, creatinine kinase-MB and troponin I levels were comparable. Interleukin-6 levels post-bypass were 61.72 ± 15.33 and 75.44 ± 31.78 pgċmL −1 ( p = 0.007) in the long-acting and St. Thomas' cardioplegia groups, respectively. Conclusions: Single-dose long-acting cardioplegia gives a cardioprotective effect comparable to repeated doses of the well-established St. Thomas' Hospital no. 1 cold blood cardioplegia.