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Blood warm reperfusion: a necessary adjunct to heart-valve surgery in low-risk patients?
P E Falcoz1, D Kaili, S Chocron
1Department of Thoracic and Cardiovascular Surgery Hôpital Jean-Minjoz, Besançon, France. pierre-emmanuel.falcoz@wanadoo.fr
Insights
Adding blood warm reperfusion to cold crystalloid cardioplegia does not improve myocardial protection in low-risk heart-valve surgery patients. Cardiac troponin I release, a marker of heart muscle damage, was similar between groups.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Myocardial Protection
Background:
- Cold crystalloid cardioplegia is a standard method for myocardial protection during heart surgery.
- The potential benefit of blood warm reperfusion in enhancing myocardial protection remains an area of investigation.
Purpose of the Study:
- To evaluate if blood warm reperfusion improves myocardial protection compared to cold crystalloid cardioplegia alone.
- To assess myocardial protection using cardiac troponin I (cTnI) release as a biomarker.
Main Methods:
- Prospective, randomized study of 70 patients undergoing first-time elective heart-valve surgery.
- Two groups: cold crystalloid cardioplegia with no reperfusion vs. cold crystalloid cardioplegia with 2-minute blood warm reperfusion.
- Serial cTnI measurements at baseline and 6, 9, 12, 24 hours post-reperfusion.
Main Results:
- No significant difference in total cTnI release between the no-reperfusion and blood warm reperfusion groups (P > 0.2).
- Individual cTnI concentrations did not differ significantly between groups at any time point.
- Higher cTnI release was observed in patients requiring inotropic support (P = 0.009).
Conclusions:
- Blood warm reperfusion does not provide additional myocardial protection when added to cold crystalloid cardioplegia in low-risk patients.
- Myocardial protection strategies may need to be tailored based on patient-specific factors, such as the need for inotropic support.
Aim:
The aim of this prospective, randomized study was to determine whether blood warm reperfusion improves myocardial protection provided by cold crystalloid cardioplegia in patients undergoing first-time elective heart-valve surgery, using cardiac troponin I release as the criterion for evaluating the adequacy of myocardial protection.
Methods:
Seventy patients with a left ventricular ejection fraction greater than 40% were randomly assigned to 1 of 2 myocardial protection strategies: 1) cold crystalloid cardioplegia with no reperfusion or 2) cold crystalloid cardioplegia followed by 2-minute blood warm reperfusion before aortic unclamping. Cardiac troponin I concentrations were measured in serial venous blood samples drawn immediately prior to cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 h.
Results:
Randomization produced 2 equivalent groups. The total amount of cardiac troponin I released (7.17+/- 14.8 mg in the crystalloid cardioplegia with no reperfusion group and 5.82+/-4.66 mg in the crystalloid cardioplegia followed by blood warm reperfusion group) was not different (P > 0.2). Cardiac troponin I concentration did not differ for any sample in either of the 2 groups. The total amount of cardiac troponin I released was higher in patients who required inotropic support (9.14 +/-16.2 mg) than those who did not (4.73+/-4.52 mg; P = 0.009).
Conclusions:
Our study shows that adding blood warm reperfusion to cold crystalloid cardioplegia provides no additional myocardial protection in low-risk patients undergoing heart-valve surgery.
