Introduction: Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is assumed that propofol, a general anesthetic agent, has a protective role against oxidative stress. The aim of this study was to evaluate the effect of propofol on myocardial protection when added to cardioplegic solution in patients undergoing CABG. Methods: In this prospective and double-blind RCT study, 120 patients undergoing CABG surgery were randomly assigned into two equal groups. In one group, we added 1200 µg/min (ultimate dose 4 µg/ml) propofol to cardioplegic solution and in the control group, an equal volume of normal saline was added to cardioplegic solution. Serum levels of CPK-MB and Troponin I were checked at four time points, including: just after induction (T1) as baseline, after chest closure (T2), 6 hours after arrival to ICU (T3) and 24 hours after ICU admission (T4). Results: Cardiac enzyme levels had significant increase over time in both groups (p-value <0.05). It was observed that the enzyme levels in the propofol group increased less compared with the control group; however, this difference was not significant. Both groups were also similar in incidence of post-operative arrhythmia and need for use of IABP. Conclusion Adding a dose of 1200 µg/min (ultimate dose 4 µg/mL) propofol to cardioplegia solution does not have an effect on CPK-MB & troponin I level.
Coronary Artery Bypass ; Cardioplegic Solutions ; Propofol

OBJECTIVETo investigate the protective effect of high-pressure carbon monoxide for preservation of ex vivo rabbit heart graft in comparison with the conventional HTK cardioplegic solution preservation.

METHODSHeart grafts isolated from 85 New Zealand rabbits were randomly divided into Naive group (n=5), HTK group (n=40) and CO group (n=40). The grafts underwent no preservation procedures in Naive group, preserved at 4 degrees celsius; in HTK cardioplegic solution in HTK group, and preserved at 4 degrees celsius; in a high-pressure tank (PO2: PCO=3200 hPa: 800 hPa) in CO group with Krebs-Henseleit solution perfusion but without cardioplegic solution. After preservation for 2, 4, 6, 8, 10, 14, 18, and 24 h, 5 grafts from the two preservation groups were perfused for 30 min with a modified Langendorff apparatus and examined for left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVDP), arrhythmia score (AS), myocardial ultrestructure, and cardiac enzyme profiles.

RESULTSAfter preservation for 6 to 24 h, the cardiac enzyme profiles and systolic and diastolic functions were significantly better in CO group than in HTK group, but these differences were not obvious between the two groups after graft preservation for 2 to 4 h. Significant changes in the myocardial ultrastructures occurred in the isolated hearts after a 24-h preservation in both CO and HTK groups, but the myocardial damages were milder in CO group.

CONCLUSIONPreservation using high-pressure carbon monoxide can better protect isolated rabbit heart graft than the conventional HTK preservation approach especially for prolonged graft preservation.

Animals ; Carbon Monoxide ; Cardioplegic Solutions ; Glucose ; Heart ; physiology ; Heart Transplantation ; Myocardium ; ultrastructure ; Rabbits ; Tissue Preservation ; methods ; Tromethamine

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 <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. RESULTS: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification > 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.
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

Cold agglutinins are predominately immunoglobulin M autoantibodies that react at cold temperatures with surface antigens on the red blood cell. This can lead to hemagglutination at low temperatures, followed by complement fixation and subsequent hemolysis on rewarming. Development of hemagglutination or hemolysis in patients with cold agglutinins is a risk of cardiac surgery under hypothermia. In addition, there is the potential for intracoronary hemagglutination with inadequate distribution of cardioplegic solutions, thrombosis, embolism, ischemia, or infarction. We report a patient with incidentally detected cold agglutinin who underwent normothermic cardiac surgery with warm blood cardioplegia.
Agglutinins* ; Antigens, Surface ; Autoantibodies ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Cold Temperature ; Complement System Proteins ; Embolism ; Erythrocytes ; Heart Arrest, Induced* ; Hemagglutination ; Hemolysis ; Humans ; Hypothermia ; Immunoglobulin M ; Infarction ; Ischemia ; Rewarming ; Thoracic Surgery* ; Thrombosis

BACKGROUND: Minimal infusion of cardioplegic solution (CPS) during aortic surgery using total circulatory arrest (TCA) may reduce several potential side effects: clamping on a diseased aorta, insult of coronary ostia, and edema. MATERIALS AND METHODS: From 2006 to 2009, 72 patients underwent aortic surgery without infusion of cardioplegic solution at the initiation of circulatory arrest. The diagnoses were acute aortic dissection (44), aneurysm (22), and intramural hematoma (6). RESULTS: The duration of TCA, the lowest nasopharyngeal temperature, bypass time, and aortic clamp time was 45 minutes, 16.4degrees C, 162 minutes, and 100 minutes, respectively. The amount of CPS was 1,050 mL, and 15 patients underwent surgery without CPS. The average inotrope score was 113 points (range, 6.25 to 5,048.5 points) corresponding to the dopamine infusion of 5 mcg/kg/min for 1 day. Seven patients showed a level of creatine kinase-MB above 50 ng/mL, postoperatively, compared with the average of 12.75 ng/mL. The ischemic change was found on electrocardiogram in 5 patients, postoperatively. There was no cardiac morbidity requiring mechanical assist. The average of intensive care unit stay and postoperative hospital stay was 40 hours (range, 15 to 482 hours) and 11 days, respectively. CONCLUSION: Minimal infusion of only retrograde CPS during rewarming without initial infusion at TCA in aortic surgery is feasible and can be used with acceptable results.
Aneurysm ; Aorta ; Cardioplegic Solutions ; Constriction ; Creatine ; Dopamine ; Electrocardiography ; Heart Arrest, Induced ; Hematoma ; Humans ; Intensive Care Units ; Length of Stay ; Rewarming

OBJECTIVETo study the protective effect of cold autologous blood cardioplegic solution on the heart of infants with cyanotic congenital heart disease (CCHD).

METHODSNinety-six infants with CCHD who underwent cardiopulmonary bypass (CPB) were randomly and equally divided into three groups: histidine-tryptophan-ketoglutarate (HTK) solution, cold non-autologous blood cardioplegic solution, and cold autologous blood cardioplegic solution. The right auricular tissues were taken before aortic cross-clamping and at 30 minutes after aortic declamping, and ATP level and energy charge (EC) in the myocardium were measured. Venous blood was collected before and immediately after CPB, and the serum levels of creatine kinase (CK)-MB and cardiac troponin I (cTnI) were measured. The clinical parameters, such as the re-beat time and re-beat rate during CPB, cardiac index, dependence on positive inotropic agents, and left ventricular ejection fraction (LVEF) at 2 hours after CPB, the incidence rate of arrhythmia within 24 hours after CPB, and postoperative complications and mortality, were recorded.

RESULTSAt 30 minutes after aortic declamping, the three groups showed significantly decreased ATP and EC levels (P<0.05), and the cold autologous blood group had significantly higher ATP and EC levels than the other two groups (P<0.05). Immediately after CPB, the three groups showed significantly increased serum levels of CK-MB and cTnI (P<0.05), and the cold autologous blood group had significantly lower serum levels of CK-MB and cTnI than the other two groups (P<0.05). The cold autologous blood group had significantly better outcomes than the other two groups in terms of the re-beat time during CPB and the dependence on positive inotropic agents and LVEF at 2 hours after CPB (P<0.05).

CONCLUSIONSCold autologous blood cardioplegic solution is superior to HTK and cold non-autologous blood cardioplegic solutions in preserving myocardial energy and reducing myocardial injury in infants with CCHD who undergo CPB, thus providing a better protective effect on the heart.

Cardioplegic Solutions ; pharmacology ; Cardiopulmonary Bypass ; Energy Metabolism ; Female ; Glucose ; pharmacology ; Heart Defects, Congenital ; metabolism ; surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Mannitol ; pharmacology ; Myocardium ; metabolism ; Potassium Chloride ; pharmacology ; Procaine ; pharmacology ; Ventricular Function, Left

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.

Adult ; Cardiac Surgical Procedures ; Cardioplegic Solutions ; Humans ; Isotonic Solutions ; Postoperative Complications ; epidemiology ; Randomized Controlled Trials as Topic

OBJECTIVETo observe the myocardial protection of cardioplegic solution with Salvia miltiorrhizae (SM) in extracorporeal circulation of coronary artery bypass graft (CABG) and to investigate the mechanisms of SM.

METHODS30 patients who received CABG under extracorporeal circulation were randomly assigned to two groups, the observation group (15 cases) and the control group (15 cases). Patients in the observation group received the cardioplegic solution with SM and those in the control group received the cardioplegic solution without SM. The indices such as serum SOD activities, MDA contents, LDH, CK-MB, cTnl levels, the rate of heart reskip, activated coagulation time (ACT), the time of assisted respiration, and the days of in-hospital after operation were observed in the two groups pre-operation, post-operation, 6 h and 24 h post-operation, respectively.

RESULTSWhen compared with the control group, MDA contents, LDH, CK-MB, cTnl levels were lower, SOD activities (all P<0.05) and heart re-skip rate (P>0.05) higher in the observation group. There was no statistical significance in the time of assisted respiration, the days of in-hospital, or ACT in the two groups (P>0.05).

CONCLUSIONSThe application of cardioplegic solution with SM in extracorporeal circulation of CABG showed obvious myocardial protection. It had better effects than the cardioplegic solution with no SM.

Aged ; Cardioplegic Solutions ; pharmacology ; therapeutic use ; Coronary Artery Bypass ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Extracorporeal Circulation ; methods ; Female ; Humans ; Male ; Middle Aged ; Myocardium ; metabolism ; Salvia miltiorrhiza

OBJECTIVETo explore the appropriate temperature of the kalium-verapamil-propranolol (KVP) cardioplegia by observation of the effect on the function of the immature rat heart.

METHODSIsolated hearts from immature rats were perfused by Langendorff method, and assigned to 1 of the following 5 groups (n = 6-8): control, continuously perfused for 170 min at 36 degrees C, normal temperature, normal perfused for 20 min, changed to perfuse with KVP for 3 min then no perfusion 87 min (ischemia 90 min), followed by 60 min reperfusion. 3 groups of low temperature, perfused for 15 min, cool down to 32 degrees C, 28 degrees C and 24 degrees C especially in 5 min, and at 20th min. heart rate (b/min), tension (g), contraction force (g), peak systolic velocity (dT/dt(max)), peak diastole velocity (dT/dt(max)), coronary flow (Drop/min) were monitored during the whole perfusion.

RESULTSCompared to control group, the heart tension increased after 50 min KVP ischemia. The protection of KVP in normal temperature (36 degrees C) was better than lower temperature (32 degrees C, 28 degrees C, 24 degrees C) such as reducing bad contraction, keeping normal myocardium tension,recovering heart rate, recovering the fuction of contraction force and protecting the coronary flow.

CONCLUSIONThe KVP cardioplegia in normal temperature has the better effect than that in hypothermia to protect the immature heart.

Animals ; Cardioplegic Solutions ; pharmacology ; Heart ; physiopathology ; Heart Arrest, Induced ; In Vitro Techniques ; Male ; Myocardial Reperfusion Injury ; prevention & control ; Rats ; Rats, Sprague-Dawley ; Temperature ; Ventricular Dysfunction ; prevention & control

AIMTo investigate the effects of polarizing cardioplegia solution with sodium channel inhibitor tetrodotoxin (TTX) on intracellular free Na+ concentration ([Na+]i) in isolated cardiomyocytes of rat.

METHODSVentricular myocytes with beating were isolated from adult rat hearts by enzymatic dissociation, randomly created in group base, group STH2 (contrast group of ischemia/reperfusion) and group TFX (treated group). Both Group STH2 and group TTX were arrested by St. Thomas No. 2 cardioplegia solution and TTX cardioplegia solution respectively, the arrest/re-beating cell model imitating MIRI being established, and imaged by laser scanning confocal microscopy (LSCM) for measuring [Na+]i of cardiomyocytes in different period. The morphology of cardiomyocytes was observed under the inverted microscope.

RESULTS[Na+]i of cardiomyocytes in both group TTX and group STH2 after re-beating was higher than that in group base (P < 0.01), and [Na+]i in group TTX was lower than that in group STH2 (P < 0.01). During arrest, the elevation of [Na+]i in group TTX was lower than that in group STH2. During arrest, the elevation of [Na+]i in group TTX was lower than that in group STH2. Morphologically, after re-beating, the ratio of active cardiomyocytes with normal form in group TTX was higher than that in group STH2 (P < 0.01).

CONCLUSIONContrast depolarized cardioplegia solution, TTX cardioplegia solution could alleviate ischemia reperfusion injury and intracellular Na+ overload of cardiomyocytes.

Animals ; Cardioplegic Solutions ; pharmacology ; Cell Hypoxia ; Cells, Cultured ; Female ; Heart Arrest, Induced ; Male ; Myocardial Reperfusion Injury ; prevention & control ; Myocytes, Cardiac ; cytology ; metabolism ; Rats ; Sodium ; metabolism ; Sodium Channel Blockers ; pharmacology ; Tetrodotoxin ; pharmacology