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Biochemical and functional effects of creatine phosphate in cardioplegic solution during aortic valve surgery--a
J Thorelius1, S Thelin, G Ronquist
1Department of Thoracic and Cardiovascular Surgery, University Hospital Uppsala, Sweden.
Insights
Supplementing cold potassium cardioplegia with creatine phosphate (CP) did not significantly alter myocardial high-energy phosphates during aortic valve surgery. However, CP supplementation showed a trend toward improved cardiac function and reduced inotropic support needs.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biochemistry
Background:
- Myocardial ischemia during surgery leads to a decrease in high-energy phosphates.
- Cold potassium cardioplegia is used to protect the heart but does not fully prevent this reduction.
- Creatine phosphate (CP) is a high-energy compound that may offer additional myocardial protection.
Purpose of the Study:
- To investigate the effect of supplementing cardioplegic solutions with creatine phosphate (CP) on myocardial high-energy phosphates and postoperative cardiac function.
- To compare the efficacy of CP-supplemented cardioplegia versus standard cardioplegia in patients undergoing aortic valve replacement.
Main Methods:
- A randomized study involving 30 patients scheduled for aortic valve replacement.
- Patients were assigned to receive either cardioplegic solution with creatine phosphate (10 mmol/L) or plain cardioplegic solution (control).
- Postoperative hemodynamic evaluation and myocardial content analysis of ATP and creatine phosphate during ischemia and reperfusion were performed.
Main Results:
- No significant differences in myocardial ATP and creatine phosphate levels were observed between the CP-supplemented group and the control group during ischemia and reperfusion.
- The CP-supplemented group showed a trend towards a better stroke-work index recovery post-bypass.
- Fewer patients in the CP-supplemented group required inotropic support compared to the control group (5/15 vs. 9/14).
Conclusions:
- Standard cold potassium cardioplegia provides sufficient myocardial protection to prevent significant reductions in ATP and creatine phosphate during ischemia and reperfusion.
- Supplementation with creatine phosphate did not demonstrate a significant impact on myocardial high-energy phosphate levels but suggested potential benefits in cardiac function recovery and reduced inotropic support needs.
Abstract:
During myocardial ischemia there is a drop in high-energy phosphates in the myocardium. Cold potassium cardioplegia decreases but does not altogether prevent this reduction. Supplementation of cardioplegic solutions with the high-energy compound creatine phosphate (10 mmol/L) compared to plain cardioplegic solutions was investigated in this study. Thirty patients scheduled for aortic valve replacement were included. The patients were randomized to group I (creatine phosphate) or group II (control). Postoperative hemodynamic evaluation revealed no significant differences between the groups. However, group I exhibited a tendency toward a better stroke-work index (135 +/- 18% vs. 102 +/- 5% recovery 15 minutes after bypass and 145 +/- 16% vs. 119 +/- 11% recovery 105 min after bypass). There were fewer patients in group I (5/15) needing inotropic support compared to group II (9/14). The myocardial content of ATP and creatine phosphate showed no significant differences during ischemia and reperfusion. It is concluded that the myocardial protection during ischemia was sufficient to prevent significant reductions of myocardial ATP and creatine phosphate irrespective of supplementation with CP.