Related Experiment Videos
Comparison between warm blood and crystalloid cardioplegia during open heart surgery
Ricardo Ferreira1, César Fraga, Fernando Carrasquedo
1Hospital Militar Central, Buenos Aires, Argentina.
Insights
Warm blood cardioplegia offers superior myocardial protection compared to cold crystalloid solutions during coronary artery bypass surgery. This study found less oxidative stress and mitochondrial damage with blood cardioplegia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biochemistry
Background:
- Myocardial protection is crucial during cardiac surgery.
- Different cardioplegic solutions are used to preserve heart function.
- Comparing the efficacy of warm blood versus cold crystalloid cardioplegia is important for surgical outcomes.
Purpose of the Study:
- To compare the myocardial protective effects of warm blood cardioplegia and cold crystalloid cardioplegia.
- To evaluate oxidative stress markers and ultrastructural changes in patients undergoing coronary artery bypass surgery.
Main Methods:
- Seventeen patients undergoing elective coronary artery bypass surgery were randomized into two groups.
- Group A received crystalloid cardioplegia, and Group B received warm blood cardioplegia.
- Blood and myocardial tissue samples were analyzed for oxidative stress markers and ultrastructural damage.
Main Results:
- Warm blood cardioplegia (Group B) showed significantly lower levels of thiobarbituric acid reactive substances (TBARS) post-reperfusion compared to crystalloid cardioplegia (Group A).
- Electron microscopy revealed significantly less mitochondrial damage in the left ventricle biopsies of patients who received warm blood cardioplegia.
- No significant differences were found in antioxidant levels (alpha-tocopherol, beta-carotene, ubiquinol) between the groups.
Conclusions:
- Warm blood cardioplegia provides superior myocardial protection compared to cold crystalloid cardioplegia.
- This enhanced protection is likely due to reduced oxidative stress and preservation of mitochondrial integrity.
- The findings suggest warm blood cardioplegia as a preferred method for myocardial preservation in coronary artery bypass surgery.
Objective:
This study was designed to compare the degree of myocardial protection afforded by warm blood and cold crystalloid cardioplegia in a group of patients undergoing elective coronary artery bypass surgery.
Methods:
Seventeen patients, were randomly assigned to Group A (n=9), who received crystalloid cardioplegic solution, and Group B who received warm blood cardioplegic solution (n=8). Before the aorta was clamped, and 10 min after reperfusion, blood samples from the coronary sinus were obtained to assay alpha-tocopherol, beta-carotene, ubiquinol, and thiobarbituric acid reactive substances (TBARS). At the same intervals, biopsies from the left ventricle were obtained to determine ultrastructural alterations.
Results:
No significant changes were observed between preischemia and reperfusion values for both blood and crystalloid groups concerning alpha-tocopherol, beta-carotene, and ubiquinol, and no differences between groups were detected. Values for TBARS in group A were 3.49+/-0.3 and 5.27+/-0.45 microM for presichemia and reperfusion samples, respectively (P<0.01). In group B values were 2.6+/-0.3 and 3.54+/-0.3 microM, respectively (P=NS). For electron microscopy studies, semiquantitative analysis showed a significant mitochondrial damage in reperfusion biopsies from group A (grades 0, 3 and 4). In group B, no significant changes were observed in mitochondrial damage between preischemia and repefusion biopsies (except for grade 0).
Conclusion:
These results indicate that blood cardioplegia affords better protection to the myocyte than crystalloid cardioplegia.