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Effectiveness of continuous warm blood cardioplegia in cardiac valve re-replacement
H Nagaoka1, K Hirooka, M Ohnuki
1Department of Cardiovascular and Thoracic Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Insights
Continuous warm blood cardioplegia (CWBC) offers superior myocardial protection during cardiac valve re-replacement compared to intermittent cold potassium cardioplegia (ICPC). CWBC significantly improves heart function recovery and reduces postoperative blood loss.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection Strategies
Background:
- Cardiac valve re-replacement necessitates enhanced myocardial protection for improved operative outcomes.
- Current methods require optimization, particularly in sternal re-entry procedures with limited cardiac exposure.
Purpose of the Study:
- To compare the efficacy of continuous warm blood cardioplegia (CWBC) against intermittent cold potassium cardioplegia (ICPC).
- To evaluate myocardial protective effects and operative outcomes in cardiac valve re-replacement surgery.
Main Methods:
- A comparative study involving 49 patients undergoing elective cardiac valve re-replacement via sternal re-entry.
- Patients were divided into two groups: 27 receiving CWBC and 22 receiving ICPC.
- Surgical technique involved narrower cardiac dissection in the CWBC group, with analysis of myocardial protection and outcomes.
Main Results:
- CWBC demonstrated a significantly higher rate of spontaneous heart-beat recovery (92.3% vs. 13.6%) post-aortic declamping (p < 0.001).
- Postoperative creatine kinase-MB levels were significantly lower in the CWBC group (p < 0.02), indicating less myocardial damage.
- CWBC patients exhibited better left ventricular stroke work index recovery, maintained normal myocardial oxygen and lactate extraction, and had significantly less postoperative blood loss (p < 0.02).
Conclusions:
- Continuous warm blood cardioplegia provides superior myocardial protection compared to intermittent cold potassium cardioplegia in cardiac valve re-replacement.
- CWBC is particularly beneficial in sternal re-entry procedures with limited cardiac exposure, leading to better operative results.
Background And Aim Of The Study:
In order to achieve better operative results, myocardial protection for cardiac valve re-replacement must be further improved. The aim of this study was to compare the efficacy of continuous warm blood cardioplegia (CWBC) with that of intermittent cold potassium cardioplegia (ICPC) in cardiac valve re-replacement.
Methods:
A total of 49 consecutive patients underwent elective cardiac valve re-replacement via sternal re-entry; 27 patients received CWBC and 22 ICPC. During surgery, a narrower dissection of the heart was used in the CWBC group. The myocardial protective effects and operative outcome were analyzed in the two groups.
Results:
Two ICPC patients died in hospital, one from cerebral bleeding and one from low output syndrome. The rate of spontaneous recovery of the heart-beat after aortic declamping was significantly higher in CWBC patients than in the ICPC group (92.3% versus 13.6%, p < 0.001). Postoperatively, maximum serum creatine kinase-MB levels were significantly lower in CWBC patients than in ICPC patients (25.5 +/- 6.0 versus 81.1 +/- 26.0 IU/l, p < 0.02). Left ventricular stroke work index in the CWBC group showed significantly better recovery in the early postoperative period compared with that in the ICPC group. Extraction of myocardial oxygen (range: 0.33 to 0.35) and lactate (range: -0.02 to 0.14) in CWBC patients was maintained within the normal range immediately after aortic declamping and in the early postoperative period. In contrast, in ICPC patients extraction of myocardial oxygen (range: 0.18 to 0.23) and lactate (range: -0.27 to -0.17) was impaired during the same period. Postoperative (24-h) blood loss was significantly less in CWBC patients than in ICPC patients (p < 0.02).
Conclusion:
In cardiac valve re-replacement surgery through sternal re-entry, and without wide exposure of the heart, continuous warm blood cardioplegia provides much greater myocardial protection than does intermittent cold potassium cardioplegia.