No abstract available.
Cardioplegic Solutions* ; Ischemia*

No abstract available.
Animals ; Cardioplegic Solutions* ; Oxygen* ; Rats*

No abstract available.
Animals ; Cardioplegic Solutions* ; Oxygen* ; Rats*

No abstract available.
Cardioplegic Solutions* ; Glucose* ; Mannitol* ; Myocardium*

No abstract available.
Cardioplegic Solutions* ; Heart* ; Thoracic Surgery*

No abstract available.
Cardioplegic Solutions* ; Heart Diseases* ; Heart* ; Hemodynamics* ; Humans

This study was designed to determine if topical cardiac hypothermia is a necessary adjunct to intraoperative myocardial protection. In this study, 105 patients ranging in age from 22 to 74 years were included. Myocardial temperature was measured at the ventricular septum. All patients received cold blood cardioplegia without topical cooling. In most of the patients(90%) the myocardial temperature was dropped to 10-15degrees C without topical cooling. In Group A, myocardial temperature was dropped rapidly to 10-15degrees C with, 1,000ml or less cardioplegic solution. In Group B, the amount of cardioplegic solution required for lowering myocardial temperature to 10-15degrees C was 1,000-2,000ml. In Group C, myocardial temperature was not dropped below 18degrees C or cardioplegic solution over 2,000ml was required for lowering myocardial temperatur. Eight patients(8/61, 8%) in group A, 12 patients(12/35, 34%) in group B and 8 patients(8/9. 89%) in group C had Complete obstructive lesions in at least one of major branches of coronary artery(p=0.001). Myocardial perfusion score was different among the groups(8.27+/-2.27 in group A, 9.98+/-2.21 in group B, 10.30+/-2.49 in group C, p<0.002). These data suggest that routine topical hypothermia may be unnecessary if myocardial temperature of less than 15degrees C could be attained with cold blood cardioplegia, especially in case of myocardial perfusion score below 10.
Cardioplegic Solutions* ; Heart Arrest, Induced ; Humans ; Hypothermia ; Perfusion ; Ventricular Septum

OBJECTIVESTo compare the cardioprotection effect between blood and crystalloid cardioplegia during cardiac surgery in adult patients, and provide a theoretical basis for optimal myocardial protection strategies.

METHODSA meta-analysis of randomized controlled trials (RCT) studies about comparing blood and crystalloid cardioplegia in adult patients undergoing cardiac surgery were performed. Cochrane library (Issue 3, 2011), MEDLINE, EMBase, PubMed, HighWire, CBM and CNKI were searched from January 1985 to December 2011. Studies were assessed according to the Cochrane Handbook for systematic reviews. Data were extracted from these trials and analyzed by RevMan5.1 software.

RESULTSSixteen trials involved 3934 patients were included, 2004 cases were in blood group, and 1930 were in crystalloid group. There was no statistical heterogeneity between studies using a fixed effects model. Meta-analysis indicated that, there were no significant differences between blood and crystalloid group in the incidence of postoperative 30 days mortality (OR = 1.11, 95%CI: 0.59 - 2.08, P = 0.74), the incidence of postoperative low cardiac output (OR = 0.98, 95%CI: 0.41 - 2.33, P = 0.85), the incidence of perioperative myocardial infarctions (OR = 0.85, 95%CI: 0.55 - 1.29, P = 0.44), and inotropic support requirement (OR = 1.05, 95%CI: 0.81 - 1.38, P = 0.70).

CONCLUSIONThe blood cardioplegia is no difference with crystalloid cardioplegia in adult patients undergoing cardiac surgery.

The removal of Ca2+ from the cardioplegic solutions could cause the danger of inducing a "calcium paradox" during reperfusion. Since intracellular Ca2+ activities are coupled to Na+ activities via Na(+)-Ca2+ exchange, an increase in intracellular Na+ activities during the cardioplegia could cause an abrupt Ca2+ influx when reperfused. To study the effects of Na+ and Ca2+ concentrations in cardioplegic solutions on intracellular Ca2+ activities during the cardioplegia and subsequent recovery period, the membrane potential and intracellular Na+ and Ca2+ activities of guinea pig ventricular papillary were measured. 1) A cardioplegia with low Ca2+ cardioplegic solution significantly decreased the overshoot and duration of the first action potential after cardioplegia, but the changes in action potential configuration were minimized after a cardioplegia with Ca2+ concentration adjusted according to the Na(+)-Ca2+ exchange mechanism. 2) Intracellular Na+ activity was continuously decreased during the cardioplegia, and the intracellular Na+ activity 20 minutes after cardioplegia was the highest with low Ca2+ cardioplegic solution. 3) Intracellular Na+ and Ca2+ activities were continuously decreased during the cardioplegia with Ca2+ concentration adjusted according to the Na(+)-Ca2+ exchange mechanism. 4) During a reperfusion of Tyrode solution after cardioplegia intracellular Na+ and Ca2+ activities were increased. Intracellular Ca2+ activity was increased more rapidly than intracellular Na+ activity. 5) The rate of increase in intracellular Ca2+ activity with reperfusion of Tyrode solution was dependent upon intracellular Na+ activity during cardioplegia, in such a way that the higher the intracellular Na+ activity was, the faster the intracellular Ca2+ activity increased. These data suggest that Na(+)-Ca2+ exchange mechanism may play an important role in the regulation of intracellular Ca2+ activity during recovery after cardioplegia.
Animal ; Calcium/*pharmacology ; Cardioplegic Solutions/*pharmacology ; Ions ; *Myocardial Reperfusion ; Osmolar Concentration ; Papillary Muscles/cytology/*drug effects ; Sodium/*pharmacology ; Solutions/pharmacology

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant. CONCLUSION: The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.
Cardioplegic Solutions ; Cardiopulmonary Bypass ; Consciousness ; Heart Arrest, Induced* ; Humans ; Intubation ; Mortality ; Potassium* ; Thoracic Surgery