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Troponin I release after CABG surgery using two different strategies of myocardial protection and systemic perfusion
R De Paulis1, A Penta De Peppo, L Colagrande
1Chair of Cardiosurgery, University of Rome, Tor Vergata, Rome, Italy. depauli@tin.it
Insights
Tepid blood cardioplegia with mild hypothermia better preserves myocardium than cold cardioplegia. This strategy reduces the release of cardiac troponin I and other biochemical markers, indicating less myocardial damage.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Anesthesia
- Cardiac Biochemistry
Background:
- Optimal temperature for blood cardioplegia and systemic perfusion remains debated.
- Investigating the impact of temperature on myocardial injury markers is crucial for patient outcomes.
Purpose of the Study:
- To compare the effects of cold versus tepid blood cardioplegia and moderate versus mild systemic hypothermia on myocardial damage markers.
- To evaluate troponin I and other biochemical markers' release under different temperature strategies.
Main Methods:
- 154 patients were randomized to either cold (27°C) or tepid (33°C) blood cardioplegia with corresponding systemic hypothermia.
- Cardiac troponin I and other biochemical markers were measured serially post-surgery.
- Statistical analysis used ANCOVA to account for baseline differences.
Main Results:
- Tepid cardioplegia and mild hypothermia significantly reduced troponin I, creatine kinase MB, and lactate dehydrogenase release.
- These benefits were independent of surgical variables like CPB time or cross-clamp time.
- No significant differences were observed in total creatine kinase, AST, or ALT release between groups.
Conclusions:
- Both cold and tepid strategies provide adequate myocardial protection with minimal damage.
- Tepid blood cardioplegia and mild systemic hypothermia demonstrate superior myocardial preservation compared to cold cardioplegia.
Background:
Controversies still exist over the optimal temperature for blood cardioplegia and systemic perfusion. This study investigates the effect of temperature of blood cardioplegia and systemic perfusion on the release of troponin I and other biochemical markers.
Methods:
One hundred and fifty-four consecutive patients were randomly assigned to one of two cardioplegic and systemic perfusion strategies of cold blood cardioplegia with moderate systemic hypothermia (27 degrees C) or tepid blood cardioplegia with mild systemic hypothermia (33 degrees C). Cardiac troponin I and other biochemical markers were measured at baseline, at the end of surgery, at 12 hours and daily thereafter. A two-way ANCOVA for repeated measure was performed to test the effect of cardioplegia on enzyme release independently of variables that were different between the two groups.
Results:
The time course of dismission of troponin I, creatine kinase MB, and lactate dehydrogenase were significantly lower with tepid blood cardioplegia and mild systemic perfusion independently of the number of distal anastomoses, CPB time, cross clamp time or total volume of cardioplegia. There were no differences between the two groups in the release of total creatine kinase, aspartate transaminase and alanine transferase.
Conclusions:
Both strategies of myocardial protection and systemic perfusion guarantee subclinical minor myocardial damage. The strategy of tepid whole blood cardioplegia and mild systemic hypothermia seems to preserve myocardium better than whole blood cold cardioplegia.