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A comparison of ischemic preconditioning versus terminal warm cardioplegia with controlled reperfusion in open heart
1Department of Cardiothoracic Surgery, Xiang Ya Hospital, Hunan Medical University, Hunan, Changsha, P. R. China. wj103612(@public.cs.hn.cn
Insights
Terminal warm cardioplegia and ischemic preconditioning significantly improve cardiac function and reduce inotropic agent use in valve replacement patients. These cardioprotection methods offer better outcomes compared to intermittent cold blood cardioplegia.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardioprotection Strategies
Background:
- Cardiac valve replacement surgery carries risks of myocardial injury.
- Effective cardioprotection is crucial for patient outcomes.
- Comparing different cardioprotection methods is essential for surgical practice.
Purpose of the Study:
- To evaluate three distinct cardioprotection methods during valve replacement.
- To assess the impact of these methods on cardiac function and clinical outcomes.
- To determine the most effective cardioprotection strategy for this patient population.
Main Methods:
- Ninety patients undergoing elective valve replacement were randomized into three groups.
- Group 1: Intermittent cold blood cardioplegia.
- Group 2: Terminal warm cardioplegia and controlled reperfusion.
- Group 3: Ischemic preconditioning followed by cold blood cardioplegia.
Main Results:
- Groups 2 and 3 required significantly fewer inotropic agents and lower doses post-operation compared to Group 1.
- Cardiac index and left ventricular stroke work index were significantly higher in Groups 2 and 3.
- Creatine Kinase-MB (CK-MB) release was lower in Groups 2 and 3, indicating less myocardial damage.
Conclusions:
- Terminal warm cardioplegia with controlled reperfusion is effective.
- Ischemic preconditioning also demonstrates significant cardioprotective benefits.
- Both strategies improve cardiac function and reduce inotropic support needs post-valve replacement.
Background:
The purpose of this study was to evaluate the effects of three different methods of cardioprotection in patients undergoing valve replacement.
Methods:
Ninety patients undergoing elective valve replacement were randomly divided into three groups. In group 1 (n=30), the patients received intermittent cold blood cardioplegia. In group 2 (n=30) they received terminal warm cardioplegia and controlled reperfusion, and in group 3 (n=30), the patients received two cycles of ischemia (2 minutes) and reperfusion (3 minutes) before heart arrest induced by cold blood cardioplegia. The parameters of cardiac function, creatine kinase MB, and clinical outcomes were recorded to assess the effects of experiment.
Results:
The major preoperative and intraoperative variables are comparable within the three groups. The number of patients requiring the support of inotropic agents was 70% (21/30), 33% (11/30) and 40% (12/30) in group 1, 2 and 3, respectively (p<0.05). The doses of inotropic agent in groups 2 and 3, were significantly lower than in group 1 (1.5+/-0.3 and 1.8+/-0.4 versus 4.5+/-0.8 microg x kg x min(-1), p<0.01) during the first 24 hours after operation. Two deaths (30 day-hospital mortality) occurred, one in group 1 and one in group 2. The cardiac index at 2 hours after bypass discontinuing were 2.2+/-0.04, 3.0+/-0.1 and 2.8+/-0.05 L/m(2) in group 1, 2 and 3, respectively (p<0.01). The left ventricular stroke work index were 24.8+/-1.3, 34.5+/-1.6 and 31.6+/-1.2 g/m x m(2) in group 1, 2, 3, respectively (p<0.01). The release of CK-MB in group 2 and 3 were lower than in group 1 (68+/-7, 81+/-9 versus 116+/-10 IU/L, p<0.01).
Conclusions:
Terminal warm cardioplegia with controlled aortic root reperfusion and ischemic preconditioning equally improve cardiac function and reduce the requirement of inotropic agents in patients undergoing valve replacement.
