Related Experiment Videos
[Clinical evaluation of myocardial protection by oxygenated crystalloid cardioplegic solutions with DBcAMP]
Y Ishikura1, S Odagiri, A Shimazu
1Department of Thoracic Cardiovascular Surgery, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan.
Insights
Adding DBcAMP and oxygenation to crystalloid cardioplegic solution (CCS) significantly improved myocardial metabolism and reduced myocardial damage during cardiac arrest. This enhanced CCS offers better protection for patients undergoing heart surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biochemistry
Context:
- Myocardial protection is crucial during cardiac surgery to prevent ischemic damage.
- Crystalloid cardioplegic solutions (CCS) are commonly used to achieve intraoperative cardiac arrest.
- Investigating methods to enhance the efficacy of CCS is an ongoing area of research.
Purpose:
- To evaluate the potential enhancement of myocardial protection by adding DBcAMP and oxygenation to a crystalloid cardioplegic solution (CCS).
- To compare the effects of non-oxygenated CCS, CCS with DBcAMP, and oxygenated CCS with DBcAMP on myocardial function and damage markers.
Summary:
- A three-group study involving 45 patients undergoing cardiac surgery compared different CCS formulations.
- Group III, receiving oxygenated CCS with DBcAMP, demonstrated significantly improved cardiac index and double product compared to Group II (CCS with DBcAMP, non-oxygenated).
- Group III also showed improved lactate/pyruvate ratio, sustained alkalosis, and significantly shorter myocardial reperfusion times, indicating enhanced myocardial metabolism and protection.
Impact:
- Oxygenation and DBcAMP addition to CCS are effectual for improving myocardial metabolism during cardiac arrest.
- This combined approach offers superior protection against myocardial damage compared to non-oxygenated or DBcAMP-only solutions.
- Findings suggest a potential improvement in patient outcomes following cardiac surgery through optimized cardioplegia.
Abstract:
Possible enhancement of myocardial protection by adding DBcAMP and oxygenation of a crystalloid cardioplegic solution (CCS) was evaluated in a three group study. The patients having coronary bypass operation or valvular operation were divided into three groups, each consisting of 15 patients, and differing only in the type of CCS employed. Group I was protected by nonoxygenated CCS (PO2 190 mmHg, PCO2, 32 mmHg, pH 7.78, K 30 mmEq/L), Group II by adding DBcAMP to nonoxygenated CCS and Group III by adding DBcAMP to oxygenated CCS (PO2 790 mmHg, PCO2 26 mmHg, pH 7.87). Group III had significantly improved CI and double product (p less than 0.05) compared with Group II. However, CPK, CPK-MB, and myoglobin in the serum were similar in each group. Lactate and pyruvate ratio (L/P) in the coronary sinus bloods were improved to lower value after the pump than before the pump only in Group III. Base excess in the coronary sinus held on alkalosis after aortic declamp only in Group III. The refunction time was significantly shortest with Group III than with other groups (p less than 0.01, 0.05) and Group II was significantly shorter than Group I (p less than 0.05). It is concluded that oxygenation and adding DBcAMP to CCS are effectual for the myocardial metabolism and protect the myocardial damage during cardiac arrest.